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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