Claims Manager
American Family Insurance GroupSalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Health InsuranceIndustries
Requirements
Candidates must possess a Bachelor’s degree in business or a related field and have a minimum of 3 years of management experience within the healthcare or medical industry over the past 5 years, along with 3+ years of experience in claims management, a proven large-scale inventory management skillset, and experience in a production-driven environment. They should also have experience managing multiple projects simultaneously and successfully, strong business acumen, analytical skills, and excellent interpersonal, organizational, communication, and presentation skills. Furthermore, candidates must demonstrate the ability to drive accountability at all levels of the organization.
Responsibilities
As the Director, Grievance and Appeals, the individual will be accountable for the day-to-day operations and performance of various complaint types handled by the Resolution team, including Part C Appeals, Provider Disputes, and other end-compliant inquiries. They will provide strategic direction and leadership to operational teams, meet or exceed operational goals including regulatory compliance, promote an “Audit Ready Every Day” culture, simplify and improve processes, collaborate with upstream business partners, support other Resolution leaders, increase Stars scores by improving timeliness and decision-making, and lead by example to cultivate a positive work environment while assessing, selecting, recognizing, developing, and empowering diverse talent.
Skills
Operational Leadership
Regulatory Compliance
Process Improvement
Team Management
Strategic Planning
Cross-functional Collaboration
Customer Service
Performance Metrics
Transformation Strategy
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Key Metrics
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees