Claims Assistant Manager

• First point of contact for customer calls that require research and a response.
• First point of contact for handling of Delta Health System employee claim inquries.
• Manages refunds and voids inventory, tasks, and ensures inventory is handled within department guidelines.
• Manages Medicare On Demands process, call outreach, CMS interaction, and required correspondence.
• Manages network adjustments, return file errors, and engagement with reconsideration teams and network partners.
• Manages enternal emails, tracks inventory, collaboration with staff for timely responses within department guidelines.
• Manages assigned adjustment inventory queues.
• Collaborate with reporting manager to ensure turn-around times, quality standards and company goals are met.
• Trend errors for assignments, identify training needs for staff, collaborate with quality assurance on unit module updates.
• Organizes department safety meetings and document handling.
• Attends staff meetings to assist with delivery of materials, trainings, and communication.
• Assists in the coordination of the work flow and control of work procedures.
• Assists with stoploss claims monitoring in collaboration with stoploss and high dollar teams.
• Provides guidance to subordinates regarding general claims and escalated issues.
• Communicates directly with clients, providers, and internal and external areas.
• Adherence to company and department policies and procedures.
• Understands the guidelines for timeliness and the expected turnaround time within the department.
• Perform other duties as assigned

Two to four years of management and claims experience. Must be computer literate w/proficiency in spreadsheet and word processing applications. Excellent written and verbal communication skills. Must have excellent leadership abilities and interpersonal skills; ability to establish confidence, rapport and foster cooperative relationships with clients, providers, and co-workers.  Must understand self-funded payer claims policies as well as Federal, State and other regulations pertaining to health insurance claims payment including TPL, COB, and coding and reimbursement methodologies.  Experience with automated claims systems; and ability to maintain sound production operations also required.

SUPERVISION: This position reports directly to a Stockton Claims Manager,  limited supervision with considerable responsibility for work quality and quantity.

Employees are eligible to apply if you are not on a disciplinary status and meet the qualifications of this position (as stated above). If you are interested in applying for this position, please forward a current resume to Human Resources by 5 pm on .

Salary : $24