Manager, Claims

About the Role:

We are seeking a Manager, Claims that will play a pivotal role in overseeing the claims processing operations within our Health Care Services organization. This position is responsible for ensuring that all claims are processed accurately and efficiently, while also maintaining compliance with industry regulations and company policies. ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. The manager will lead a team of claims specialists, providing guidance and support to enhance their performance and professional development. Additionally, this role involves analyzing claims data to identify trends and areas for improvement, ultimately aiming to enhance customer satisfaction and operational efficiency. The successful candidate will contribute to the overall success of the organization by implementing best practices and fostering a culture of excellence within the claims department.

Minimum Qualifications:

• Bachelor's degree in Health Care Administration, Business Administration, or a related field.
• A minimum of 5 years of experience in claims processing or management within the health care industry.
• Strong knowledge of health care regulations, insurance policies, and claims processing systems.
• Relevant experience may substitute for the educational requirement on a year-for-year basis

Preferred Qualifications:

• Master's degree in a relevant field.
• Certification in claims management or a related professional designation.
• Experience with data analysis tools and software.

Responsibilities:

• Oversee the daily operations of the claims processing team, ensuring timely and accurate claims adjudication.
• Develop and implement policies and procedures to improve claims processing efficiency and accuracy.
• Conduct regular training sessions for claims staff to enhance their skills and knowledge of industry regulations.
• Analyze claims data to identify trends, discrepancies, and opportunities for process improvement.
• Collaborate with other departments, such as billing and customer service, to resolve complex claims issues and enhance the overall customer experience.

Skills:

The required skills for this position include strong leadership abilities, which will be utilized to motivate and guide the claims team towards achieving departmental goals. Excellent analytical skills are essential for interpreting claims data and identifying areas for improvement, ensuring that the organization remains competitive and compliant. Effective communication skills will be crucial for collaborating with other departments and addressing any claims-related issues that arise. Additionally, proficiency in claims processing software will enable the manager to streamline operations and enhance productivity. Preferred skills, such as experience with data analysis tools, will further support the manager in making informed decisions that drive operational excellence.