Manager, Claims

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Manager, Claims oversees the daily operations of the mailroom dedicated to processing claims-related correspondence and initial stages of the claims process, ensuring that all claims are loaded in claims processing system timely and accurately. Additionally, this role is responsible in ensuring efficient handling, sorting, distribution of mail and preprocessing of claims, while maintaining compliance with company policies and regulatory requirements. The Manager is also responsible for overseeing vendor performance in relation to claims operational support, including but not limited to scanning and printing fulfillment services.

General Duties/Responsibilities
1.    Manage the Claims pre-processing and Mailroom team, providing guidance, training, and performance development to optimize team effectiveness.
2.    Ensure timely and accurate loading of all claims into the claims processing system.
3.    Collaborate with other Claims leaders to facilitate the efficient routing of misdirected claims and deliveries of claims related letters.
4.    Develop and implement essential metrics related to claims pre-processing and mailroom processes, clearly communicating expectations to team members.
5.    Oversee the sorting, scanning, and distribution of incoming and outgoing claims-related mail and documents.
6.    Establish and maintain standard operating procedures to ensure streamlined and efficient claims operations.
7.    Design and implement vendor performance metrics, utilizing scorecards and dashboards for transparent communications.
8.    Monitor vendor performance to ensure adherence to service level agreements and consistent quality.
9.    Ensure compliance with all relevant regulations and company policies regarding claims handling and da-ta privacy.
10.  Analyze workflow processes to identify opportunities for improvement, enhance efficiency and accuracy.
11.  Address any issues or discrepancies related to initial stages of claims and mail processing in a timely and effective manner.
12.  Develop and maintain positive working relationships with business areas, IT, and vendors.
13.  Maintain a positive and productive work environment through clear communication and employee sup-port.
14.  Communicate organizational changes or updates to vendors and staff to ensure alignment with business needs.

Supervisory Requirements:

Fulfill supervisory responsibilities in accordance with organization policies and applicable laws.  Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems

JOB REQUIREMENTS:

Experience:

Required: 5 years experience managing claims staff, in either healthplan, IPA or MSO settings experience

Education:

Required: High School Diploma or General Education Development (GED).

Preferred: Bachelor’s degree in business or other related field or equivalent years of experience

Specialized Skills

Required:

• Claims processing experience preferably in a Medicare healthcare setting.
• Leadership Skills: Ability to lead, motivate, and develop a diverse team while fostering a positive workplace culture
• Communication Skills: Strong verbal and written communication skills for effective interaction with staff and stakeholders.
• Interpersonal Skills: Ability to build relationships and collaborate across departments.
• Analytical Skills: Proficiency in analyzing performance metrics and using data to inform decision-making.
• Organizational Skills: Strong ability to prioritize tasks and manage time effectively.
• Problem-Solving Skills: Ability to address challenges proactively and develop effective solutions.
• Technical Proficiency: Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).
• Strong ethical standards and integrity.
• Adaptability to changing environments and business needs.
• Knowledge of relevant laws and regulations related to employment and labor.
• Experience in conflict resolution and handling employee grievances.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $70,823.00 - $106,234.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Salary : $70,823 - $106,234