- Company:
Universal Health Care - Location:
St. Petersburg, FL 33701 - Job Status/Type:
Full Time
Employee - Job Category:
Accounting/Finance/Insurance - Occupations:
Claims Review and Adjusting - Industry:
Insurance - Work Experience:
2+ to 5 Years - Career Level:
Manager (Manager/Supervisor of Staff) - Education:
Bachelor's Degree
- Company:
Universal Health Care
Claims Manager
| Description: | Under administrative direction, the purpose of this position is to manage claims. Position will perform review, evaluation, analysis, and investigation of all claims and liability issues. Employee will ensure maintenance of complete, accurate, and detailed documentation concerning all claims investigation and adjustment activities. Position will manage all inventory levels and monitor to ensure claims are processed accurately and timley. Position will ensure compliance with established regulatory standards in the conduct of all work. This person will manage the claims staff to ensure departmental goals and performance expectations are being met/exceeded. |
| Duties: | - Investigate, research, organize and analyze claims - Review and monitor all open claim activity - Manage cases by working with and providing direction to staff - Negotiate resolutions of high exposure and complex cases - Ensure that all customer service obligations are met - Handle complaint calls from customers - Develop solutions to pending problems - Ensure compliance with all company and state regulatory requirements - Perform General Liability claim audits - Complete performance analysis and define protocols of claims adjudicator - Set up adjuster handling procedures, client reporting procedures and provide claim reporting manuals to staff - Perform claim review and compile monthly and quarterly status reports, reserve tracking reports, trend analysis reports, charts and graphs along with any summary details on significant accounts - Educate clients on claims processes - Serve as in-house resource for other departments - Cooridnate with other key departments such as Provider Operations, Member Services, Enrollment etc |
| Qualifications: | Completion of a Bachelor's Degree in Insurance Management, Business Administration or related field is preferred - Five (5) years of experience in a supervisory role within a claims environment, including some computer skills, knowledge of regulations and general claims handling experience is preferred - Effective organizational, oral and written communication skills to enable accurate completion of assignments - Constructive interaction with others strongly desired |
