Manager, Claims Operations - Remote, Illinois

Job Description

As the Manager, Claim Operations you will play a key role in Guidehealth’s expansion and growth.  You will provide operational oversight to the claims production and the inventory and reporting teams to ensure all required KPIs and Metrics are being met.  This role will report to the Sr. Director, Claims Operations.

WHAT YOU'LL BE DOING

Responsible for the day-to-day management of the Claim Operations team.

Maintains and improves claims processing operations by monitoring system performance; identifying and resolving problems; preparing and completing action plans.

Assessing and assigning workflow, coaching, counseling. 

Use reporting data analytics to track KPIs and report to leadership on a daily, weekly, monthly basis.

Monitor individual Analysts quality and production measures, conducting staff performance conversations, monthly 1:1’s with individual staff to review their concerns, give feedback, mentor goals and career progression.

Responsible for writing and maintaining desktop procedures for claims processing functions.

Identify areas within the claims workflow and system tools where the processes can be improved/enhanced, analyzing current workflows, designing and implementing changes to streamline operations and monitor the impact of those changes to ensure increased efficiency and production.

Leveraging technological advantages and incorporating new workflows to scale the business.

Responsible for the distribution and completion of assigned JIRA tickets relating to claims inquiries or adjustments requests.

Complete first round of claims processing reviews on client reporting requirements prior to sending for their approval.

Coordinate operational workflows and other internal functions alongside departments and managers.

Participate in the Monthly Policy and Procedure committee meetings, complete review of policies to approve or suggestions for updates.

Conduct at minimum monthly team meetings, and attend operational meetings as requested.