Claims Resolution Manager

Baptist Health

Claims Resolution Manager responsible for leading a claims follow-up team at Baptist Health. Ensuring resolution of underpaid or denied claims through efficient team management and analysis.

Posted 7/30/2026full-timeJacksonville • Florida • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Denials Management, Hospital Claims Follow-Up, and Payer Strategy, while effectively leading a team to enhance claims resolution processes. Proven ability to implement Process Improvement initiatives and mentor team members to optimize performance and motivation.

Highest-signal resume keywords

Denials Management ExperienceHospital Claims Follow-Up ExperienceLeadership ExperiencePayer Strategy ExperienceProcess Improvement Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ResolutionAppeals ManagementStrategic PlanningWorkload DistributionMentorshipEffective DelegationCritical ThinkingDecision MakingMetrics AnalysisTeam Development

Soft Skills

Open CommunicationIntrinsic Motivation

Industry Keywords

Managed CareGovernment PayersInternal Process GapsPayer Related IssuesQuality Claims Resolution

About the role

Key responsibilities & impact

Leads a team dedicated to physician billing claims follow up who can determine why a claim is underpaid or denied taking the necessary steps to resolve the claim to payment.
The manager possesses critical thinking skills and the ability to implement processes that improve efficiencies, optimize team members strengths, and consider system abilities or limitations.
There is a focus on quality claims resolution rather than claim touch or productivity and enhancing team members skillsets and intrinsic motivation to find a solution to claim payment.
The manager has experience in both Managed Care and government payers and is capable of distinguishing internal process gaps versus payer related issues.
Duties include strategic planning for staffing needs and cross training, workload distribution, and team member development such as mentorship, effective delegation, and open communication.
The manager is driven to find solutions and confident in making decisions based on pertinent information and metrics.

Requirements

What you’ll need

3-5 Years - Denials Management Experience (Required)
3-5 Years - Experience Hospital Claims Follow-Up Experience (Required)
3-5 Years - Leadership Experience (Required)
3-5 Years - Payer Strategy Experience (Required)
1-2 Years - Process Improvement Experience (Required)
5+ Years - Relevant equivalent experience in lieu of education (Required)
3-5 Years - Appeals Management Experience (Required)
Bachelor's Degree - Required

Benefits

Comp & perks

Hybrid work arrangement
Professional development opportunities