At CHCS Services, we are committed to providing innovative healthcare solutions while fostering a supportive and inclusive work environment for our employees. We can succeed together as a team by investing in our employees’ well-being and professional development. Thank you for considering CHCS Services for your healthcare needs and employment opportunities.
Job Summary
The Manager responsibilities are to provide leadership, direction and management to the Claim Department. Responsible for the overall planning and implementation of claims efficient productivity processes and client focused service delivery. Monitor and control costs while maintaining exceptional service levels and determine strategies that will increase the company’s profitability. Establish specific performance expectations, service delivery requirements and audit programs to ensure adherence to policy and procedures. Assist in designing and implementing goal-oriented training programs for new and existing team members.
Supervisory Responsibilities: Yes
Directly supervises and manages the Associates within the Claim Department. The Manager will carry out supervisory responsibilities in accordance with the organizational policies/procedures and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems/issues.
Duties/Responsibilities:
- Provide leadership and guidance to Team Leads to develop highly skilled, results oriented and customer focused teams that consistently meet and/or exceed service levels and performance standards.
- Establish clear and concise performance matrix, service levels and implement processes that monitor gap analysis and incorporate corrective action planning.
- Oversee the set up and delivery of strategic training programs for inexperienced and experienced claims personnel and encourage external training.
- Develop, recommend, and implement strategic programs and procedures that encourage customer loyalty, company profitability and cost-effective productivity.
- Ensure that Claim Department is adequately staffed, and team members are provided with the appropriate resources to provide exceptional client
- Direct all aspects of recruitment and develop interview techniques and tests to ensure the selection of qualified candidates.
- Establish procedures with, and act as a liaison to other business
- Handle and resolve escalated customer/client call and complex contentious claims. Resolve claims issues by collaborating with team members, compliance, and other internal/external stakeholders.
- Represent Claims during meetings and inter departmental
- Represent Claim Department during internal/external presentations
- Other duties that may be
Required Skills/Abilities:
Leadership Skills; Critical Thinking; Adaptability/Flexibility; Change Management; Analytical/Problem Solving; Good Judgement, Decision Making; Interpersonal Skills
Ability to read, analyze, and interpret complex documents; ability to respond effectively to the most sensitive inquiries or complaints; ability to write policies and procedures; ability to make effective presentations; ability to exhibit excellent verbal and written communication skills.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to compute rate, ratio, and percent and to draw and interpret graphs. Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, analysis of variance.
Ability to define problems, collect data, establish facts, and draw valid conclusions. Education and Experience:
Associate or bachelor’s degree from College or University preferred; two to seven years of managerial related experience in claims operations, insurance and/or healthcare environment; or equivalent combination of education and experience.
AHIP, ICA and/or LOMA certifications desired. Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus.