Claims Manager in West Miami, FL at Signature Consultants

Date Posted: 9/4/2019

Job Snapshot

Job Description

Claims Manager Overview:

Signature Consultants is seeking a Claims Manager for an opportunity in W. Miami, FL. The Claims Manager manages the operational activities and staff of the Claims Department in accordance with the Company guidelines, client needs, and legislative requirements.

Responsibilities:

  • Must be capable of resolving escalated issues arising from operations and requiring coordination with other departments.
  • Manage daily activities and functions of claims team for all accounts.
  • Must be responsible for overseeing daily operations of the claim department to ensure claims are processed timely, accurate and in compliance with all federal and state healthcare plan laws and regulations.
  • Acts as Subject Matter Expert in issues related to claims processing, payment dispute resolution, cost containment, audit processes and contract interpretation.
  • Develops, implements and updates Policy and Procedures to ensure compliance with CMS and HIPPA regulations.
  • Report overpayments, underpayments, and other irregularities
  • Design and implement various policies and procedures for claims
  • Provide services to all business requirements and ensure optimal handling of all claims and investigate all issues and provide training for all business units.
  • Actively collaborate with management and staff to ensure that "best practices" are followed and continually seek efficient and innovative processes, technologies and approaches to optimize use of resources and enhance operations.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

Minimum Qualifications:

  • Bachelor's Degree or equivalent experience
  • 3-5 years of Claims Management experience in healthcare organization
  • 3-5 years of experience where you were responsible for setting standards and goals that met or exceeded company and client Service Level Agreements (SLA's)
  • Demonstrated experience developing and lading process improvement projects that drove operations efficiencies
  • Entrepreneurial mindset geared toward the creation, execution and continuous improvement of health plan operations and implementations
  • Excellent written and oral presentation skills
  • Demonstrated exceptional active listening and communications skills
  • English / Spanish


About Signature Consultants, LLC

Headquartered in Fort Lauderdale, Florida, Signature Consultants was established in 1997 with a singular focus: to provide clients and consultants with superior staffing solutions. For the ninth consecutive year, Signature was voted as one of the "Best Staffing Firms to Work For" and is now the 14th largest IT staffing firm in the United States (source: Staffing Industry Analysts). With 27 locations throughout North America, Signature annually deploys thousands of consultants to support, run, and manage their clients' technology needs. Signature offers IT staffing, consulting, managed solutions, and direct placement services. For more information on the company, please visit www.sigconsult.com.