Front Line Healthcare Claims Manager

A Claims Manager in the healthcare field manages and administrates direction of billing for medical services provided to patients in order to ensure they receive care in the most efficient manner. They work to plan, organize, and direct a medical claims department. Responsibilities Ensure process is executed as per the client contract Conduct briefings before every shift to drive focus on key metrices and debrief at the end of the shift to drive focus of the team on quality and adherence to contract compliance processes Prepare notes from the huddle meetings and share it with the team Prepare and share the performance data of the team with the client at the end of the shift Interact with the client and prepare note to share updates and changes with the team Review the performance on the key process metrices and conduct RCA to improve quality parameters Prepare presentation on weekly and monthly performance data for the manager to be shared with the client Collaborate and influence internal key stakeholders to manage and resolve issues to ensure fulfillment and flawless delivery of projects Be part of the discussion between manager and WFM team on forecast and number of agents required Organize fun hours on Friday for the team to promote team engagement Identify opportunities for automation within the account and share it with the manager Provide details and data to the automation team to support the automation initiative Skills Drive performance of the team on the identified metrics of the process Review last 6-8 weeks performance data (RAG) and identify low performers Provide feedback and coach the outliers/ low performers to improve their performance metrics Prepare Performance Coaching & Counselling Plan (PCCP) to document and support the low performers Handhold the employees on performance on process and monitor for improvements Identify training needs for new joiners especially and track their daily progress Conduct process trainings as well as refresher trainings are provided to bridge the capability gap or if there is any change from the client’s end FMEA knowledge and familiarity Experience in creating SOPs & Process Mapping Experience overseeing a department of 50 or more agents and support personal Stakeholder Interaction & Management Coordinate with internal and external stakeholders to ensure compliance and quality in the delivery for accounts Interact and engage with the client manager to communicate and update progress against account plan, project delivery etc. Participate in monthly review meetings with Account Delivery leadership updating them on the status and progress of the account Work with quality team to ensure the quality improvements as per the delivery standards of the contract Provide timely assistance in case of an escalation and support resolution of escalations/ issues Effective Team Management Resourcing Hire adequate and right resources for the team Talent Management Ensure adequate onboarding and training for the team members to enhance capability & effectiveness Build an internal talent pool and ensure their career progression within the organization Manage team attrition Drive diversity in leadership positions Performance Management Set goals for the team, conduct timely performance reviews and provide constructive feedback to own direct reports Ensure that the Performance Nxt is followed for the entire team Employee Satisfaction and Engagement Lead and drive engagement initiatives for the team Track team satisfaction scores and identify initiatives to build engagement within the team Job Type: Full-time Pay: $72,800.00 per year Benefits: 401(k) 401(k) matching Dental insurance Flexible schedule Health insurance Life insurance Paid time off Paid training Vision insurance Wellness program Schedule: 8 hour shift Day shift Monday to Friday Application Question(s): You need to have experience overseeing 50 or more agents/support personnel. Do you have that experience? Experience: Claims Manager: 5 years (Required) Ability to Commute: Tampa, FL 33634 (Required)