Medical Claims Manager

Job Description

We are seeking a Medical Claims Manager to oversee the efficient processing of healthcare claims. The ideal candidate will have a strong background in claims management, ensuring that all claims are processed accurately and in a timely manner. You will work closely with healthcare providers to resolve any issues that may arise.

Responsibilities

• Supervise the claims processing team to ensure high performance.
• Evaluate claims submissions for completeness and accuracy.
• Investigate claims for fraud or billing errors.
• Liaise with insurance companies for claim approvals and rejections.
• Maintain a high level of confidentiality regarding patient information.
• Develop and implement strategies to optimize claims management.
• Assist with policy updates and procedural improvements.
• Support patients in understanding their claims and benefits.
• Prepare performance reports for senior management review.

Requirements

Education

• Bachelor's degree in Nursing, Health Information Management, or related field
• Master's degree in Healthcare Administration is a plus

Experience

• 5+ years of experience in healthcare claims or related field

Technical Skills

• Insurance Verification
• Billing and Coding

Soft Skills

• Negotiation
• Team Collaboration

Certifications

• Health Insurance Portability and Accountability Act (HIPAA) Certification
• Certified Medical Reimbursement Specialist (CMRS)

Languages

• English: Fluent

Advantageous

• Experience with auditing claims submissions: Able to perform audits to ensure correctness in claims.
• Experience with patient advocacy: Understanding of the patient experience and claims process.

Benefits

• Medical aid and comprehensive health cover
• Performance bonuses based on KPIs
• Remote working options available
• Training and development opportunities

Company Culture

• Professional Growth: We are committed to the continuous development of our employees through training and mentorship.
• Diversity and Inclusion: We embrace diversity, ensuring all voices are heard and valued in our team.
• Work-Life Balance: We promote a healthy work-life balance, offering flexibility where needed.