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Manager, Claims
Location:
Pittsburgh, PA
Description:
Title: Manager, Claims Department: Claims Bargaining Unit: NBU Grade: N/A Position Type: Exempt Hours per Week: 40 Position Summary The Manager, Claims provides daily leadership and supervision to multiple Claims teams in accordance with Company guidelines, client needs, and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role." Key Duties and Responsibilities Provides daily leadership and supervision to staff consistent with management values and mission. Assigns, distributes, and monitors quality and quantity of work produced ensuring appropriate quality and production internal service level agreements have been met; maintains employee accountability for quotas and service level expectations. Develops staff through performance management, goal setting, training, and effective employee relations. Optimizes workflows/processes, tools, and staff allocation to ensure efficient and cost-effective day to day operations. Maintains current knowledge of assigned Plan(s) and effectively applies knowledge; provides oversight of processing activities to ensure compliance. May attend client meetings and interface with clients on claims-related issues to ensure client requirements and changes in benefit programs are implemented. Maintains effective communications and working relationships with management, other departments, staff, governmental agencies, clients, unions, participants, attorneys, and consultants. Troubleshoots customer/client service issues and assists in the successful implementation of new clients. Assists in the development and documentation of departmental SOP's. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Seven years of experience processing complex health and welfare claims in a third-party administrator. Three years of experience in a supervisor or management role in claims operations. Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes. Thorough knowledge of claims operations to include payment of claims, interpretation of contracts, communication of benefits, etc. Experience with analysis, staffing models and workforce management and managing a remote workforce. Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly. Highly developed sense of integrity and commitment to customer satisfaction. Ability to communicate clearly and professionally, both verbally and in writing. Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities. Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment. Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications Understanding of Taft-Hartley environment. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at XXXX@zenith-american.com , and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently seeking an experienced Manager, Claims with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 40 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more! Internals to Apply: If you meet the minimum qualifications and are interested in applying for the above position, please submit an application. All applications must be received by 5:00 pm on the Internal Posting Deadline listed above in order to be considered prior Job Posted by ApplicantPro
Company:
Zenith American
Posted:
December 26 2023 on ApplicantPro
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More About this Listing: Manager, Claims
Manager, Claims is a Executive Manager Job at Zenith American located in Pittsburgh PA. Find other listings like Manager, Claims by searching Oodle for Executive Manager Jobs.
Manager, Claims is a Executive Manager Job at Zenith American located in Pittsburgh PA. Find other listings like Manager, Claims by searching Oodle for Executive Manager Jobs.