Healthfirst

The Claims Manager will be responsible for overseeing the daily operation of 50+ examiners handling new claims inventory, mail correspondence, appeals, special handling and web portal requests. This includes managing staff performance (e.g. production and accuracy), resource allocation, and staff training to ensure all claims are processed accurately and timely in accordance with regulatory and corporate requirements.

Duties & Responsibilities: The Claims Manager is responsible for assisting examiners with clarification on claims processing. In addition, managing and communicating with both in-house and telecommuting staff. The incumbent is required to work in the office while managing staff that work from home. This includes face-to-face meetings with rotating telecommuting staff on a daily basis. •Performance Management - Responsible for performance and resource management of examining staff handling new claims inventory, mail correspondence, appeals, special handling and web portal requests. •Inventory & Time Management - Responsible for all aspects of aging inventories for New Claims and Special Handling requests (e.g. Mail Correspondence, Web Portal, Provider Service Calls, etc.). Ensure that all claims are processed accurately and timely in accordance with regulatory and corporate metric and requirements. •Planning and Control - Present and report daily, weekly and monthly status and trends on examiner production, quality, and claims inventory levels to the Director of Claims. This includes offering recommendations and submitting corrective action plans on improvement and consistency (as needed). •Problem Solving - Analyze and trend inventories, performance results, and requests to determine root cause. Evaluate opportunities to improve the handling and routing of claims using MACESS workflow system. Work in conjunction with other operating units to analyze results and identify areas for process and quality improvement while providing timely feedback to examiners. •Resource Management & Staff Development - Manage personnel-related matters including performance planning and appraisal, salary administration, hiring, training, progressive disciplinary actions in accordance to company policy and resolve personnel related concerns/issues. Identify the need of training and development of policy, procedures and job-aids to aid examiners on increasing performance and processing of all types of claims. •Communication - Required to work in-house (100 Church Street, New York, NY) while managing staff that work from home. Communicate daily with both telecommuting and in-house staff. Investigate and follow-up on all requests, concerns, and problems affecting examiner performance and claims inventories (includes following up with internal/external sources). Minimum Qualifications: High School Diploma. Previous supervisory or managerial experience with claims examining operations (e.g. Claims Processing and Adjudication processes). Experience maintaining large claims inventory, which includes tracking metrics of time service standards, payments of claims and notification of claims received, etc. Experience overseeing performance management (production based metrics) and staff development of assigned personnel (You will be responsible for 50+ claims examiners). Experience identifying root cause issues with staff performance and implementing corrective actions plans when needed. MS Excel experience manipulating spreadsheets to create standardized reports, utilize vLookups, pivot tables, filter and use formulas. Experience hiring Claims Examiners or related staff. Preferred Qualifications: Bachelor’s degree or higher in healthcare or related managed care field. Mathematical skills with proficiency in analyzing reports and data. Familiarity with ICD-9/ICD-10, CPT coding and medical terminology. Healthcare industry experience in a hospital, commercial insurance company, or managed care organizations. Experience with managing telecommuting staff. Understanding of New York State Department of Health requirements for managed care benefit issues and claims processing requirements. Excellent oral and written communication skills Ability to be objective and professional when involved in conflict resolution with staff.

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $79,300 - $114,580 All Other Locations (within approved locations): $69,800 - $103,870 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.