Manager, Claims
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At a glance
Job overview
Sanford Health is hiring a Manager, Claims. The Claims Manager, under the general supervision of the Sanford Health Plan Director of Claims, oversees health insurance claims submitted by providers and patients. This role involves implementing and managing day-to-day process activities related to claims research and resolution, including reviewing and testing claims, benefits, and fee schedules. The manager also serves as a resource to claims department employees and other departments, handles personnel issues, and coordinates claims processing and adjustment activities.
Key focus areas include Implement and manage day-to-day process activities related to claims research and resolution, Review and/or test claims, benefits, and fee schedules to ensure correct processing, and Serve as a resource to all employees in the claims department and other departments.
Successful candidates bring 3 Years Team Lead Experience, 3 Years Management Role In Claims Processing, and 3 Years Management Role In Similar Environment. Important skills include Claims Research, Claims Resolution, Claims Processing, Benefits Assignment, Pricing Calculation, and Policy Development.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Careers With Purpose
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.
Facility: GSS SD N Sioux City Northport Location: North Sioux City, SD Address: 749 Streeter Dr, North Sioux City, SD 57049, USA Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00
Department Details
This position allows some work from home options as well as a flexible schedule
Job Summary
The Claims Manager is under the general supervision of the Sanford Health Plan Director of Claims, in the areas of health insurance claims submitted by providers and patients for processing. Responsible for the implementation and day-to-day performance of process activities related to claims research and resolution. The process includes the review and/or testing of claims, benefits and fee schedules to ensure claims process correctly. Accountable as a resource to all employees in the claims department as well as other departments in the organization. Responsible for the interviewing, hiring, discipline of employees and any other personnel issues that arise. Completes performance appraisals. Coordinates claims processing and adjustment activities within the claims department. Manages claims inventory, ensuring accurate and timely processing. Knowledge of various lines of business that the Sanford Health Plan services and how to differentiate services. Understands the details of professional and institutional claim processing which includes how benefits are assigned and pricing is calculated. Works to help develop and maintain claims policies and procedures. Must communicate effectively with a high level of diplomacy. Demonstrates analytical ability and a good awareness of pertinent details. Assimilates large amounts of information to maintain a broad knowledge base. Exercises good judgement in determining the best method for handling a variety of situations. Maintains good working relationships with staff, physicians, and enrollees. Handles pressure effectively. Maintains confidentiality. Other duties as assigned.
Qualifications
Bachelor's degree preferred.
Three years in a team lead or management role in claims processing or similar environment required.
Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to [email protected] .
Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0264853 Job Function: Health Plan Featured: No
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