Claims Manager
Kin Insurance$120,000 - $150,000/year
Full Time
Senior (5 to 8 years)
$70,000 – $80,000Compensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries
Requirements
- Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims
- Strong leadership and team management skills, with the ability to effectively manage and motivate a team
- Ability to analyze claims data and make informed decisions based on findings
- Previous experience in claims processing or a related field, including supervisory experience
- Understands health insurance benefit administration in a Self-Funded environment
- Ability to read and understand various forms, documentation, files, and information with the department
- 5 years or more experience with healthcare claims administration, self-funded preferred
- Experience leading and delegating tasks to multiple direct reports
- Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
- Proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment
- Proficient experience in MS Word, Excel, Outlook
Responsibilities
- Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans
- Ensures that claims, appeals, and adjustments are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
- Manages the inventory of claims against standard service level agreements (SLAs)
- Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement
- Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
- Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance
- Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems
- Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance
- Liaison for the CMAS Team on various projects and/or initiatives including claims and testing needs to support system implementations and/or upgrades
- Performs other duties as deemed essential and necessary
Skills
Claims Adjudication
Healthcare Claims Processing
Benefit Administration
Appeals Management
Quality Assurance
Team Management
SLA Management
Policy Development
Performance Metrics
Client Benefit Plans
Centivo
Affordable health insurance with primary care focus
About Centivo
Centivo provides health insurance focused on making healthcare affordable and accessible. The company emphasizes primary care, offering free primary care services, no deductibles, and low, predictable copays to help keep its members healthier and reduce the need for hospital visits. Centivo generates revenue by charging employers for health plans provided to their employees, which leads to lower medical costs and increased usage of the plans. A key feature of Centivo's offering is its integrated virtual care service, allowing members to access care conveniently. The company is distinguished by its commitment to quality, curating providers based on strict price and quality standards, particularly in primary care. Centivo's goal is to enhance the member experience while lowering overall healthcare costs.
Buffalo, New YorkHeadquarters
2017Year Founded
$183.7MTotal Funding
DEBTCompany Stage
Financial Services, HealthcareIndustries
201-500Employees