What are the responsibilities and job description for the Manager Claims Operations position at Independence Blue Cross and Careers?
Manages associates in completing department functions and ensures that the area of responsibility runs in a cost effective and quality manner providing prompt, accurate, and professional responses. Ensures timely and accurate processing of claims processing for all products (PA & NJ) for Local and BlueCard business, including Government products Medicare Advantage & MediGap.
- Represents IBX in group and government audits and legal matters in a business capacity
- Maintains oversight vendor activities
- Handle compliance, regulatory and delegation tasks, including meetings.
- Achieve and maintain performance standards for the department in accordance with BCBSA and PA & NJ requirements
- Evaluate the effectiveness and efficiency of operational areas and take action to reallocate resources as necessary.
- Manage work processes, measure non-conformance and identify corporate and department policies and procedures to achieve operational efficiencies.
- Interpret, communicate, and implement corporate and department policies and procedures.
- Maintain positive working relationships with internal and external customers to resolve departmental issues.
- Approve special consideration and handling for customers as appropriate.
- Compile and prepare required data pertaining to unit performance, budget, training, surveys, projects, audits, attendance, etc.
- Identifies the support and implementation of process improvements that impact overall service and reduces overall costs.
A. A high school diploma or equivalent is required.
B. 5 years’ experience in a health care or related setting, with two years in a leadership capacity
- Comprehensive knowledge of claims operations, including processes, regulations, and best practices.
- Excellent interpersonal and leadership skills to effectively interact with direct reports, internal teams, and external customers.
- Strong organizational skills and attention to detail in a fast-paced environment that change frequently.
- Problem-solving ability to identify issues, develop resolutions, and educate customers on solutions.
- Exceptional communication skills with the ability to engage and convey information clearly across all levels of the organization.