Senior Manager of Claims at Meridian in Detroit, MI

Save or bookmark jobs as you go and access them anytime later with your account.

Contacts

Description

Overview

Who we are:

Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.

 

We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.

 

Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

 

A Day in the Life of a Manager of Claims:

 

The Senior Manager of Claims coordinates and supervises activities within the Claims Department under the direction of the Vice President of Claims    This position ensures that claims are processed accurately and timely in compliance with claims processing requirements as indicated in the Claims Policy and Procedure guidelines.  This position is resolves customer inquiries promptly and courteously

Responsibilities

  • Direct activities of claims department. Ensure that staff members maintain adequate expertise in claims processing, eligibility, and policy interpretation, while meeting or exceeding production and accuracy standards.
  • Oversight of multiple claim teams
  • Motivate through leadership while providing guidance to direct reports aligning with Meridian’s Core Values. Passion, Integrity, Quality and Vision
  • Ensuring clarity around priorities and goals for the entire functional areaReview and advise on those claims with the highest complexity and sensitivity, and those that exceed claims examiners payment authorizations
  • Develop, Implement and maintain a strategy to maximize auto adjudication of claims to exceed 85%
  • Develop, implement and maintain an error claim rate less than 2%
  • Adhere to all State, Federal and other applicable guidance, regulations and laws.
  • Abide by all Centers for Medicare & Medicaid regulations
  • Identify requirements for future training needs
  • Interface with internal and external personnel to resolve issues and inquiries
  • Handle Third Party Liability investigations and complete necessary reporting to the State
  • Administer and adhere to company and department policies and procedures
  • Recommend and assist in acquisition of technology and other tools or equipment and resources to optimize departmental performance and outputPerform other duties as assigned

Qualifications

What you can bring to Meridian:

  • Bachelor’s Degree or Fellow designation from the Academy for Healthcare Management (AHM) is required.
  • Previous experience in a leadership role is required
  • Minimum of 4 -5 years of Claims managment experience strongly preferred
  • Knowledge of all aspects of claims processing
  • Thorough knowledge of CPT and ICD-10 coding
  • Knowledge of claims policies and procedures
  • Working knowledge of PC application
  •  Strong organizational, planning, analytical, and communication skills
  • Excellent interpersonal skills necessary to interact with all levels of personnel
  • Ability to problem solve

What Meridian can offer you:

 

  • Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
  • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
  • Meridian offers 401k matching that is above the national average.
  • Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
  • Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.

 

Equal Opportunity Employer

Similar Jobs

See All »

Other Jobs at Meridian

See All »