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MANAGER OF CLAIMS SUPPORT

Company: HealthSmart
Location: Irving
Posted on: September 13, 2020

Job Description:

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About HealthSmart

HealthSmart is the premier provider of customizable and scalable health plan solutions for self-funded employers. We reduce costs and improve outcomes, all the while treating our health plan members with dignity and respect. But that's just the beginning of our story - We make differences in peoples' lives every single day!

Our HealthSmart team understands the difference we make when treating others with dignity and respect, which is why we embody our mission by promoting a diverse and inclusive culture.

We're a company of innovators.

We deliver health benefit plans and solutions to provide worry-free, self-funded plan administration, quality coverage, and innovative care.

We provide care management services that change lives and helps employers and members take control of healthcare costs.

HealthSmartRx Solutions delivers extremely attractive pharmacy benefits with an Rx discount program.

Our Network Solutions group offers national, comprehensive provider networks to provide member access to the right care.

HealthSmart Casualty Claims Solutions leverages technology, robust information and unmatched experience to deliver innovative casualty claims management solutions with outstanding results.

We offer business intelligence and web-based reporting. Plus, we offer a variety of health and wellness initiatives and even onsite employer clinics.

POSITION SUMMARY
At HealthSmart, the Manager of Claims Support will investigate guidelines, inquiries, and ensure compliance in procedures, proper services and settlement of claims while leading 15-20 team members for a business unit. They will also track/report metrics and assist senior management in developing and establishing policies and procedures. Overseeing investigations and consultations with legal counsel, including providing daily team management to Customer Service staff will ensure we continue to meet or exceed daily requirements/service standards.

Skills and Qualifications

* 5+ years' experience handling Medicare Advantage claims in Managed Care/TPA environment

* 3+ years' experience in healthcare leadership

* Microsoft Office skills

* Proven ability to meet/exceed business goals

Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

* Direct proper healthcare claims operations within compliance

* Follow and communicate policies and procedures to team members and senior management

* Monitor all call volume/activity in order to meet or exceed business goals

* Review abandonment rates, time to answer, and hold times to ensure we deliver service standards

* Train, review, and evaluate team members to establish goals and encourage growth

* Track, report, and generate quality and production reports as required

* Resolve escalated calls as necessary

Physical Requirements

* While performing the duties of this job, the employee is frequently required to sit, talk and hear

* The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms

* The employee must occasionally lift and/or move up to 30 pounds

* Specific vision abilities required by this job include close vision and the ability to adjust focus

* The work is performed primarily in an office setting

* The noise level in the work environment is moderate

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.

HealthSmart 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.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed..

Keywords: HealthSmart, Irving , MANAGER OF CLAIMS SUPPORT, Executive , Irving, Texas

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