Medical Claims Review Manager jobs in Lansing, MI

Hybrid Remote in Lansing, MI.
Will consider candidates for a Remote opportunity. Must be able to accommodate EST office hours and reside within the U.S. 

Provide leadership and direction to a claims operational team that focuses on Workers' Compensation Medical Bill Review.  Act as a primary, independent, visionary and proactive authority; providing in-depth analysis of claims operational areas including statistical, industrial and regulatory perspectives.  Provide operational consistency and integrity to claims. Serve as a technical expert with regard to department operations.

RESPONSIBILITIES/TASKS:

• Directly manage and carry out managerial responsibilities in accordance with enterprise policies and applicable laws.  Responsibilities include interviewing, hiring and training employees, planning, assigning, and directing work, appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems.
• Plan, direct, manage and evaluate the day-to-day operations and workflow of production, claims management and customer teams.
• Consult with claims management across the organization to provide necessary claim support and ensure most productive and cost effective ways to conduct business.
• Responsible for staying current on changes in workers’ compensation statutes and cases, as well as subrogation and recovery laws and procedures.
• Responsible for developing and implementing policies, practices and procedures.
• Conduct advanced statistical analysis and research related to claims and claims operations.
• Serve as department representative to customer inquiries, brands and enterprise.
• Oversee and manage strong, professional working relationships of state departments, as well as vendors by serving as a key contact. This would include ensuring quality communication and exceptional work product.
• Oversee state filing projects (i.e., quarterly benchmarking as well as annuals) to ensure timely completion.
• Keep detailed records of all delays, surcharges and fines received from multiple jurisdictions. 
• Participate in development of annual departmental budget.

DIRECTION EXERCISED: 

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.  Responsibilities include but are not limited to effectively interviewing, hiring, terminating and training employees, planning, assigning and directing work, appraising performance, rewarding and counseling employees, addressing complaints and resolving problems, supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the job.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS

EDUCATION:

Bachelor’s degree in insurance, business or a related field.  Combination of relevant education and experience may be considered in lieu of degree.  Continuous learning required, as defined by the Company’s learning philosophy. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Five years experience of progressive responsibility in a claims environment with demonstrated technical knowledge that provides the necessary skills, knowledge and abilities. Working knowledge of workers' compensation statutes, filing procedures, settlement options, claims processes, and medical terminology. Minimum three years of demonstrated leadership ability in a claims environment required. 

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Extensive knowledge of workers compensation insurance and the claims management process.
• Demonstrated leadership ability.  Knowledge of team-building and employee motivation theories with the ability to effectively manage multi-functional employee teams.
• Ability to bridge IT requirements and departmental needs.
• Ability to read, analyze and interpret financial information.
• Excellent oral and written communication skills.
• Excellent analytical skills to identify improvement needs and develop solutions.
• Ability to effectively exchange information clearly and concisely, present ideas, report facts and other information and respond to questions as appropriate.
• Strong interpersonal skills and the ability to negotiate while creating and maintaining mutually beneficial relationships with working partners.
• Ability and proficiency in the use of computers and company standard software, including advanced knowledge in Excel, Access and other corporate databases.
• Ability to establish workflows, manage multiple projects and meet necessary deadlines.
• Ability to comprehend the consequences of various problem situations and address them or refer them for the appropriate decision-making.  Independently resolves most problems.
• Ability to make competent, independent decisions.
• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
• Ability to maintain confidentiality.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Some travel may be required.  Must possess a valid driver’s license with a record that meets corporate standards.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

Pay Range 
“Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $77,300 and $129,400.”  

We are an Equal Opportunity Employer.  Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis.  Nothing herein is intended to create a contract.