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Claim Manager

Salary undisclosed

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Key Responsibilities:
TPA Setup and Management
Establish TPA Operations: Develop and implement the structure, policies, and procedures for the new TPA company, ensuring alignment with industry standards and regulations.
Staff Recruitment and Training: Hire and train staff for the TPA, including claims processors, customer service representatives, and administrative personnel.
Technology Implementation: Oversee the selection and implementation of claims management software and technology solutions to streamline operations.
Claims Processing
Claims Management: Supervise the entire claims process from submission to resolution, ensuring accuracy and timeliness.
Compliance: Ensure compliance with healthcare regulations, coding standards, and payer requirements in claims processing.
Dispute Resolution: Handle escalated claims disputes and appeals, working closely with patients, providers, and insurance companies to resolve issues.
Communication and Reporting
Stakeholder Communication: Serve as the primary point of contact for internal and external stakeholders, including insurance providers, patients, and healthcare professionals.
Performance Metrics: Develop and monitor key performance indicators (KPIs) for the claims process, providing regular reports to clinic management on performance and trends.
Qualifications:
Education: Bachelor’s degree in healthcare administration, business, or a related field; a master’s degree is a plus.
Experience: Proven experience in claims management, preferably in a healthcare setting, with prior experience in TPA operations.