Medicare Claim Supervisor (Hybrid)

About the position

We are seeking a dedicated and detail-oriented Claims Manager to oversee our claims processing operations. The ideal candidate will have a strong background in medical terminology, risk analysis, and negotiation skills. This role requires an individual who can effectively manage a team, analyze claims data, and ensure compliance with Medicare guidelines and medical coding standards. The Claims Manager will play a crucial role in enhancing our claims management processes while maintaining high levels of accuracy and efficiency.

Responsibilities
? Oversee the daily operations of the claims department, ensuring timely and accurate processing of claims.
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? Analyze claims data to identify trends, discrepancies, and areas for improvement.
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? Negotiate with insurance providers and other stakeholders to resolve claim disputes.
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? Ensure compliance with Medicare regulations and medical coding requirements.
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? Review medical records and documentation to validate claims submissions.
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? Conduct risk analysis to mitigate potential losses related to claims processing.
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? Provide training and support to team members on medical terminology, DRG (Diagnosis Related Group) coding, and best practices in claims management.
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? Collaborate with other departments to streamline processes and improve overall efficiency.

Requirements
? Proven experience in claims management or a related field, preferably within the healthcare or insurance industry.
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? Strong knowledge of Medicare policies, medical terminology, and medical coding practices.
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? Familiarity with auto restoration processes is a plus.
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? Excellent analytical skills with the ability to interpret complex data sets.
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? Demonstrated negotiation skills with a track record of successful outcomes.
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? Mechanical knowledge is beneficial for understanding related claims processes.
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? Ability to work independently as well as part of a team in a fast-paced environment.

Nice-to-haves
? Experience with auto restoration processes.

Benefits
? 401(k)
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? 401(k) matching
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? Dental insurance
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? Employee assistance program
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? Flexible schedule
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? Health insurance
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? Life insurance
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? Paid time off
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? Parental leave
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? Retirement plan
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? Vision insurance

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