Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review 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. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Why Jencap? We are one of the largest wholesale insurance intermediaries in the United States with expertise in wholesale brokerage, binding authority, and program management. The common thread woven throughout our success story is our collaborative and driven team of people. Our teams are empowered and work together to find solutions. We have a passion culture – with teamwork, collaboration and a focus on growing individuals and giving them the tools & development opportunities to have a successful career.
HRMP, a Jencap company, is a third-party administrator for risk takers and is uniquely positioned to offer business solutions to carriers, reinsurers, and underwriters. We provide a variety of services and solutions within the insurance market such as stop-loss program administration, group life and medical conversions, auditing services, back office or run-out administration, quota share and excess medical reinsurance.
The Claims Manager supports medical insurance customers (including administrators, MGUS, brokers) by confirming eligibility, determining insurance coverage, examining and resolving medical stop loss claims, documenting actions, maintaining quality customer service, ensuring compliance.
This is a remote opportunity.
Responsibilities:
Requirements:
Want the opportunity to build something new? Have your voice be heard, your skills properly applied, and to add tangible value to an organization? You're in the right place. Expand your knowledge and stretch your experience through new and emerging risks. Jencap is dynamic, bold, tenacious and trusted in the industry.
Here, you are not just one of the many, you are one of us. We truly are better together.
The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The base pay range for the Claims Manager will be $95,000 - 110,000/year. Discretionary incentive compensation may be awarded. Jencap also offers a range of benefits and programs, based on eligibility, which currently include but are not limited to; comprehensive health care coverage, a 401k plan, and tuition reimbursement. Jencap is an emerging and rapidly growing leader in the industry and as such, we approach talent acquisition as an opportunity to identify the best talent. Therefore, the level of the role and compensation may vary depending upon the best available candidate.
Jencap is an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin or citizenship status, sexual orientation, gender identity or expression, pregnancy, marital or familial status, disability status, medical condition, genetic information, military or veteran status, political affiliation, or any other characteristic protected by law. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard, as we believe that that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients.
Any unsolicited resumes and candidate profiles submitted through our web site or to e-mail accounts of employees of Jencap are considered property of Jencap unless specifically engaged on the active search by a leader of the company. In order to be an authorized Agency/Search Firm for Jencap, any such agency must have an existing formal written agreement signed by an authorized Jencap HR leader and an active working relationship with the organization. If the candidate submission process is not followed, no agency fees will be paid by Jencap.
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