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Posted on 7/26/2021

Medical Insurance Claims Manager


Bellwood, IL


The Medical Insurance Claims Manager will be responsible for managing the day-to-day operations with new claims, settlements, legal review and appeals, and any additional investigations, on a case-by-case basis. The ideal candidate will have extensive experience in both simple and complex claims, as well as TPA desk-level procedures. The candidate should be detail oriented, able to collaborate with other team members, possess strong managerial and communication skills, and be able to resolve issues as they arise. Additional responsibilities will be to provide overall support and leadership to the claims department.

  • Create and implement sustainability and consistency across claims operations and reporting in various applicable platforms
  • Participate as a "subject matter expert" in projects that impact the organizations continued growth and financial success
  • Coordinate and interact with third parties (health plan providers, IT consultants, external/internal vendors, benefit system administrators, former TPA, etc.) before, during, and after claims pay transition to ensure the system and department are fully operational
  • Assist in department creation (staff claims processors, assess hardware/equipment requirements, etc.)
  • Create and implement payment processes
    Provide benefit system testing to ensure proper functionality
  • Coordinate data migration and reporting data accurately
    Develop and coordinate strategy for litigation
  • Comprise and analyze data for bill presentation based on requirements and review claims for quality
  • Process claims for Medical, Vision, Dental, Short Term Disability, and Supplemental Benefits
  • Monitor effectiveness of all programs and provide support to all open claim file reviews and manage all payment cycle to ensure compliance to all Plan requirements.
  • Analyze all claims and identify all risks and ensure processing of all claims as per Plan/Fund policy.Issuing responsible and timely disbursement of funds.
  • Consulting with and requesting approval of appropriate superiors on disbursements in excess of assigned authority.
  • Reporting necessary information to outside Fund professionals as needed.
  • Provide other internal operational departments with needed claim information.
  • Provide education, claim review, evaluations, consultation, and/or assistance to each claim adjustor.
  • Proven knowledge of claim procedures, policies, terminology, etc., including coverage analysis background and knowledge of claims practices.

  • 5+ years of experience in claims processing for a healthcare organization
  • 2+ years of managerial experience in claims management for a healthcare organization
  • Bachelor's Degree in Business Administration or another related field
  • Familiarity with ISSI Claims Processing Systems
  • Extensive experience with MS Office Suite
  • Intermediate knowledge of basic medical terminology
  • Expertise in analyzing and interpreting discrepancies in data collection, billing, and accounts receivable
  • Experience with multi-employer Taft-Hartley health and welfare funds desired.
  • Experience with Blue Cross Blue Shield of Illinois procedures desired.
  • Excellent interpersonal skills.
  • Demonstrates strong problem solving and analytical ability.
  • Must be able to prioritize and handle multiple assignments simultaneously and meet established deadlines.
  • Please send responses via e-mail referencing Job:13360 to Your resume will be forwarded.
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