What are the responsibilities and job description for the Manager Claims Operations position at Guidehealth?
Job Description
As the Manager, Claim Operations you will play a key role in Guidehealth’s expansion and growth. You will provide operational oversight to the claims production and the inventory and reporting teams to ensure all required KPIs and Metrics are being met. This role will report to the Sr. Director, Claims Operations.
WHAT YOU'LL BE DOING
- Responsible for the day-to-day management of the Claim Operations team.
- Maintains and improves claims processing operations by monitoring system performance; identifying and resolving problems; preparing and completing action plans.
- Assessing and assigning workflow, coaching, counseling.
- Use reporting data analytics to track KPIs and report to leadership on a daily, weekly, monthly basis.
- Monitor individual Analysts quality and production measures, conducting staff performance conversations, monthly 1 : 1’s with individual staff to review their concerns, give feedback, mentor goals and career progression.
- Responsible for writing and maintaining desktop procedures for claims processing functions.
- Identify areas within the claims workflow and system tools where the processes can be improved / enhanced, analyzing current workflows, designing and implementing changes to streamline operations and monitor the impact of those changes to ensure increased efficiency and production.
- Leveraging technological advantages and incorporating new workflows to scale the business.
- Responsible for the distribution and completion of assigned JIRA tickets relating to claims inquiries or adjustments requests.
- Complete first round of claims processing reviews on client reporting requirements prior to sending for their approval.
- Coordinate operational workflows and other internal functions alongside departments and managers.
- Participate in the Monthly Policy and Procedure committee meetings, complete review of policies to approve or suggestions for updates.
- Conduct at minimum monthly team meetings, and attend operational meetings as requested.
Qualifications : Qualifications
WHAT YOU'LL NEED TO HAVE
What we’d love for you to have
Additional Information
The salary for this role is $80,000.00 per year.
BENEFITS :
While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include :
COMPENSATION :
The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to : skill set, years of relevant experience, education, location, and licensure / certifications.
OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT
Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.
OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA
This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.
REMOTE WORK TECHNICAL REQUIREMENTS
Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.
Compensation :
65,000-$65,000 per year
Salary : $65,000 - $80,000
