Gerente Senior de Reclamos Position Available In Hillsborough, Florida

Senior Claims Manager Location:

Tampa, FL Salary:

$90,000-110,000 Direct Hire Opportunity! Kelly Services has an amazing opportunity for a driven Senior Claims Manager to join a leading 3rd party Health Benefits Administrator based out of their Tampa, FL location. This is a Direct Hire opportunity with a salary range of $90,000-110,000 per year based on experience, in addition to an excellent benefits package. In this role you will provide operational leadership to the team responsible for processing the billing for healthcare services provided to patients. Further, this candidate will develop and share knowledge of products, benefits, quality requirements and organization procedures. Apply today for immediate consideration! Responsibilities include but not limited to: Support claims leaders and team members to ensure claims are allowed or denied based on actual services rendered, legislative requirement and plan agreements. Direct and lead claims processing function for claims leaders and team members ensuring metrics are met or and exceeded; incorporating positive feedback and reward mechanisms Hire and manage staffing levels to ensure continuous, quality processing Conduct effective resource planning to maximize productivity and turn-around time Follow and maintain knowledge of Federal and State regulations; implement changes regarding claims and billing requirements Recommends and implements best practices to ensure complete and thorough claims settlements, legal reviews, and investigations following company policy and insurance regulations Develop, revise and monitor metrics in order to meet division quality, time service and productivity goals Prepare and present repots on claims processing metrics, trends, and outcomes Monitor inventory levels and aging of claims and assist with workflow assignments. Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claim Develop and implement training for employees, collaborating with the training and auditing functions to supplement and support as needed Determines the value of settlements for escalated claims Identify and coordinate resources for re-work Analyze and identify trends and provide robust reports

Skills and Requirements:

Bachelor’s degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience 5+ years of experience in a supervisory role in a healthcare claims processing role where HIPPAA and HITECH standards are utilized Experience with benefit administration platforms such as Javelina preferred Knowledge of Federal and State codes related to fiscal operations of healthcare services Knowledge of medical terminology and Diagnosis Codes (ICD-9 & ICD-10) Ability to analyze and interpret problems in data collection, billing, and coding.