Medical Claims Manager

𝐉𝐎𝐁 𝐒𝐔𝐌𝐌𝐀𝐑𝐘
As a Medical Claims Manager, you will be responsible for overseeing the medical claims process, ensuring accuracy, and maintaining a high standard of service. This role offers an exciting opportunity for a qualified individual to contribute to the success and growth of our medical claims operations.

𝐐𝐔𝐀𝐋𝐈𝐅𝐈𝐂𝐀𝐓𝐈𝐎𝐍𝐒, 𝐒𝐊𝐈𝐋𝐋𝐒 & 𝐄𝐗𝐏𝐄𝐑𝐈𝐄𝐍𝐂𝐄:
1. Medical degree (MD or equivalent) is preferred.
Proven experience in a leadership role within the medical claims department of an insurance company.
2. In-depth knowledge of medical claims processes, healthcare procedures, and insurance regulations.
3. Strong analytical and decision-making skills, with attention to detail.
4. Excellent communication and interpersonal abilities.
5. Familiarity with medical advancements and industry trends.
6. Ability to lead and motivate a team to achieve departmental goals.

𝐉𝐎𝐁 𝐑𝐄𝐒𝐏𝐎𝐍𝐒𝐈𝐁𝐈𝐋𝐈𝐓𝐈𝐄𝐒:
1. Manage and lead the medical claims department, ensuring smooth and efficient operations.
2. Oversee the processing of medical claims, including verification, validation, and adjudication.
3. Utilize medical expertise to assess the accuracy and appropriateness of claims submissions.
4. Collaborate with healthcare providers, policyholders, and internal teams to resolve complex claims issues.
5. Stay informed about medical advancements, industry regulations, and insurance policies affecting claims.
6. Provide guidance and support to claims processing staff, fostering a culture of excellence.
7. Ensure compliance with regulatory requirements and company policies.
8. Conduct regular reviews of claims processes to identify areas for improvement.
9. Act as a liaison between the claims department and other stakeholders, including insurance partners and regulatory bodies.
10. Contribute to the development and implementation of claims management strategies.