Claims Operations Manager
Gainwell Technologies
full-time
Posted on:
Location Type: Office
Location: Helena • Montana • United States
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Salary
💰 $73,900 - $105,500 per year
About the role
- Supervise and coordinate the daily operations of the claims department, ensuring timely and accurate claims processing.
- Establish and monitor performance metrics, service level agreements (SLAs), and department goals.
- Coach, mentor, and develop claims staff, including performance evaluations and training initiatives.
- Review and resolve complex or escalated claims issues, ensuring compliance with company policies and regulatory standards.
- Implement process improvements to enhance efficiency, accuracy, and customer satisfaction.
- Oversee the use of claims management systems and ensure data integrity and confidentiality.
- Collaborate with underwriting, customer service, legal, and finance teams to address interdepartmental issues and support business objectives.
- Prepare and present regular reports on claims operations, trends, and key performance indicators (KPIs) to senior management.
- Maintain up-to-date knowledge of industry regulations, trends, and best practices.
- Handle customer complaints and inquiries with professionalism, ensuring prompt resolution and positive outcomes.
Requirements
- Bachelor's degree in business administration, insurance or related field
- Five (5) or more years of healthcare (Medicaid/Medicare) claims processing or insurance operations experience
- Two (2) or more years of leadership or supervisory experience in a claims processing or insurance operations environment
- Proficient in claims management software and Microsoft Office Suite.
- Strong knowledge of healthcare insurance claims processes, and regulatory requirements.
Benefits
- Health (medical, dental, vision) benefits start on day 1 of employment.
- Company match 401K and other benefits available within months of starting.
- New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment.
- Company provided computer for work use.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingperformance metricsservice level agreementsprocess improvementsdata integrityclaims management softwareMicrosoft Office Suiteregulatory compliancecustomer satisfactionperformance evaluations
Soft Skills
supervisioncoachingmentoringcommunicationproblem-solvingcollaborationcustomer serviceleadershiptrainingprofessionalism
Certifications
Bachelor's degree