Manager Claims (Remote in USA)

Summary

The Kansas fiscal agent Claims Manager is a contract-specified role responsible for routine claims/encounter processing operations. Candidate oversees a team that includes data entry, claims resolution, financial and third-party liability reporting, and electronic data interchange (EDI) transactions. This position has frequent interaction with the client.

Your role in our mission

• Plans, develops and manages administration of routine to moderately complex claims programs to ensure proper claims policies, practice and procedures are adhered to.
• Manages and approves small to medium billing statements, claims and associated administrative activities to ensure compliance with law, regulation, policies agreements, and contractual arrangements.
• Manages, as necessary, intercedes with third parties in unusual situations involving payment or adjustment of charges on accounts; consults with departments concerning services with affect collection of charges.
• Participates in developing and implementing policies and procedures consistent with those of the organization to ensure efficient and safe operations of the unit.
• Selects and hires employees. Trains and evaluates employees to enhance their performance, development, and work product. Addresses performance issues and makes recommendations for personnel actions. Motivates and rewards employees including providing salary increases, bonuses, and promotions within allocated budgets and company guidelines.

What we're looking for

• Bachelor's degree in business administration, insurance or related field, preferred
• Nine (9) or more years of claims experience required
• Three (3) or more years of supervisory experience required
• Experience working with healthcare proper claims handling, policies, procedures, applicable laws, regulations and practices regarding the insurance industry required
• Experience working with insurance and/or medical terminology required

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
  • Mainly will work from home but must be willing to travel for possible client/corporate meetings.
• For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
• Upward career advancement is possible and encouraged.
• 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. Any exception requires manager approval prior to employee's Gainwell start date.
• Company provided computer for work use after being hired.
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• This position will remain posted to collect applications until October 29, 2025.

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