Claims Processing Manager jobs in San Antonio, TX

Claims Processing Manager manages the administration of health insurance claims, payment processing, billing research, and responding to inquiries. Ensures timely and proper disposition of claims in accordance with coverage amounts. Being a Claims Processing Manager trains staff on organizational policies and ensures procedures are followed at all times. Provides guidance on more complex or high-value claims. Additionally, Claims Processing Manager typically requires a bachelor's degree. Typically reports to a head of a unit/department. The Claims Processing Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Claims Processing Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)

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Claims Manager
  • HealthTexas
  • San Antonio, TX FULL_TIME
  • Job Purpose
    The Claims Manager is responsible for overseeing and directing delegated Managed Care Claims adjudication and manage our medical claims department.
    In addition, you will be responsible for contributing to the growth and success of HealthTexas while upholding our Mission, Vision and Values.
    Culture and Values Expectations
    At HealthTexas, we believe that our workplace culture is the cornerstone of our success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission “to deliver quality and compassionate care with outstanding service, every patient, every time”. As a Claims Manager at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.
    • Integrity: Do the right thing, the right way, every time.
      • Be honest and uphold commitments and responsibilities, earn the trust and respect of the team and those we serve, and maintain privacy and confidentiality.
    • Compassion: Treat everyone with respect and dignity.
      • Foster an environment of inclusivity and well-being, practice patience and empathy, and assume positive intent.
    • Synergy: Collaborate to improve outcomes.
      • Invite and explore new opportunities, promote effective communication and teamwork, take pride in yourself, your work and HealthTexas.
    • Stewardship: Use resources responsibly and efficiently.
      • Implement effective strategies to attain goals, achieve maximum productivity and results, and seek continuous knowledge and improvement.
    Essential Job Duties & Responsibilities
    • Participate in inter-departmental business activities, including input into budget preparation
    • Prepare inbound and outbound 835, 837, EFT, etc.
    • Encourage positive staff results by communicating job expectations; planning, monitoring, and appraising results; coaching, counseling, and implementing corrective action plans when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
    • Complete performance evaluations in a timely manner.
    • Create, review, and/or update departmental procedures, workflows, and resource material.
    • Implement necessary policy and regulatory changes.
    • Develop and manage auditing and quality control standards.
    • Supervise the coordination of workflow and staffing of day-to-day activities as well as assigning and monitoring work of staff in order to adhere to productivity and quality standards to meet stated goals.
    • Manage delegated claims audit and reporting.
    • Ensure CMS and delegated claims compliance.
    • Resolve and/or gather appropriate guidance for any escalated issues.
    • Other duties, as assigned
    Experience
    • Minimum 5 years medical claims adjudication working experience, with at least 3 years of managerial experience
    • Medicare guidelines and healthcare claims regulation knowledge
    • Delegated Medicare Advantage Experience is required
    • Experience with claims adjudication software

    Education
    • Bachelor’s Degree preferred. In lieu of a degree, 6 or more years of relevant experience
    Knowledge, Skills & Abilities
    • Medicare guidelines and healthcare claims regulation knowledge
    Work Hours, Travel Requirements
    • Monday – Friday, 8:00 a.m. – 5:00 p.m., and as needed to complete projects.
    • Travel to medical offices may be necessary for the purpose of providing benefit education.

    Working Conditions & Physical Requirements
    • This job operates in an office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
    • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
  • 1 Month Ago

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Workers Compensation Claims Adjuster
  • TheBest Claims Solutions
  • San Antonio, TX OTHER
  • Workers Compensation Claims Adjuster SAN ANTONIO, TX 78201 | DIRECT HIRE $75,000 TO $83,000 ANNUALLY, DEPENDING ON EXPERIENCE Job Description Our client, a leading insurance company, is currently seek...
  • 20 Days Ago

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Automotive Claims Adjuster
  • Alternative Claims Management
  • San Antonio, TX FULL_TIME
  • Location: Remote (Texas, Florida, North Carolina, South Carolina, Michigan, Wisconsin, Georgia, Mississippi, Ohio) Hours: Monday to Friday 8:30 am - 5:00 pm WHO WE ARE We are a damage recovery expert ...
  • 1 Day Ago

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Claims Adjuster/Handler/Specialist (FT)
  • Alternative Claims Management
  • San Antonio, TX FULL_TIME
  • ***Hiring Soon***Location: REMOTE (Texas, Florida, North Carolina, Michigan, Wisconsin) Competitive Hourly Pay Performance-Based CommissionHours: Monday to Friday 8:30 am - 5:00 pm WHO WE ARE:We are a...
  • 18 Days Ago

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Medical Insurance Claims Manager
  • HealthTexas
  • San Antonio, TX FULL_TIME
  • Job PurposeThe Claims Manager is responsible for overseeing and directing delegated Managed Care Claims adjudication and manage our medical claims department.In addition, you will be responsible for c...
  • 1 Month Ago

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Regional Sales Executive
  • BASYS Processing
  • San Antonio, TX FULL_TIME
  • Summary Maintain a positive work atmosphere by behaving and communicating in a manner consistent with the mission, vision and values of the organization. Develop and maintain bank relationship to obta...
  • 20 Days Ago

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0 Claims Processing Manager jobs found in San Antonio, TX area

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ITSM Problem Manager
  • Leidos
  • San Antonio, TX
  • Description Looking for an exciting opportunity to make an impact as ITSM Problem Manager? 1901 Group (A Leidos Company)...
  • 4/25/2024 12:00:00 AM

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Integrated Project Management Lead
  • Jones Lang Lasalle Incorporated
  • San Antonio, TX
  • Integrated Project Management Lead page is loaded Integrated Project Management Lead Apply remote type Remote locations ...
  • 4/24/2024 12:00:00 AM

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Contract Onsite Urgent Hiring :: Process modeler support Analyst :: San Antonio TX (Onsite) :: Contr
  • Diverse Lynx
  • San Antonio, TX
  • Job Title: Process modeler support Analyst Location: San Antonio TX (Onsite) Contract Mode of interview: Video Call Note...
  • 4/24/2024 12:00:00 AM

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Transactional and Technical Topics Business Combinations & Impairments - Audit Manager
  • EY
  • San Antonio, TX
  • EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these q...
  • 4/24/2024 12:00:00 AM

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Vice President of Operations
  • Brookdale Senior Living
  • San Antonio, TX
  • Overview Vice President of Operations-Senior Leadership Opportunity with an industry leader! Region includes: TX, LA, KS...
  • 4/24/2024 12:00:00 AM

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Reimbursement Business Advisor, Botox - San Antonio & Austin
  • AbbVie
  • San Antonio, TX
  • Company Description AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious he...
  • 4/24/2024 12:00:00 AM

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Oracle Services - C2M/CC&B Designer/Developer - Manager - US Consulting - Open Location
  • EY
  • San Antonio, TX
  • EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these q...
  • 4/23/2024 12:00:00 AM

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Transformation Manager Principal
  • United Services Automobile Association
  • San Antonio, TX
  • Why USAA? Let's do something that really matters. At USAA, we have an important mission: facilitating the financial secu...
  • 4/22/2024 12:00:00 AM

San Antonio (/ˌsæn ænˈtoʊnioʊ/; from Spanish, "Saint Anthony"), officially the City of San Antonio, is the seventh-most populous city in the United States, and the second-most populous city in both Texas and the Southern United States, with more than 1.5 million residents. Founded as a Spanish mission and colonial outpost in 1718, the city became the first chartered civil settlement in present-day Texas in 1731. The area was still part of the Spanish Empire, and later of the Mexican Republic. Today it is the state's oldest municipality. The city's deep history is contrasted with its rapid rec...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Processing Manager jobs
$89,853 to $116,050
San Antonio, Texas area prices
were up 1.2% from a year ago

Claims Processing Manager in Austin, TX
These claims management platforms are often not well integrated with peripheral systems, which also results in more human involvement and an increased cost per transaction.
January 26, 2020
Claims Processing Manager in Topeka, KS
The claims have to be handled timely to ensure quick settlement leading to customer satisfaction.
January 12, 2020
Managers can review workflow queues and see what is in each processor’s queue.
January 13, 2020
Claims Processing Manager in Youngstown, OH
A common duty in this position is reviewing insurance policies after clients have submitted claims, in order to determine coverage.
December 11, 2019