Job Summary
The primary objective of this role is to direct and mentor a claims operations team by allocating tasks and overseeing their execution to ensure precise and prompt claims adjudication and optimal service delivery. The role includes managing reporting functions, reconciling payments, addressing escalated claims issues, and implementing process enhancements while providing expert support in claims to both team members and business partners.
Responsibilities
- Lead and mentor the claims operations team, ensuring effective task assignment and performance monitoring.
- Guarantee accurate and timely adjudication of claims and elevate service standards.
- Oversee reporting processes and conduct payment reconciliations.
- Handle escalated claims and drive process improvements.
- Provide claims-related expertise to employees and stakeholders.
Qualifications
- A high school diploma or equivalent is required.
- Minimum of three years of relevant professional experience is essential.
- Preferred supervisory experience in claims operations.
- Experience with healthcare or medical claims is advantageous.
- Familiarity with HealthRules Payor or a similar claims management platform is desirable.
- Strong skills in communication, coaching, and managing operational performance are preferred.
Medica provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
