Medical Claims Review Manager jobs in Lincoln, NE

Wilcox Companies is seeking an experienced Health Insurance Claims Manager to oversee the claims processing and adjudication for our health insurance division. As a Health Insurance Claims Manager, you will be responsible for ensuring that all claims are processed accurately, efficiently, and in compliance with state and federal regulations. You will also oversee a team of claims specialists and ensure that they are meeting performance goals and providing high-quality customer service to our members.

Key Responsibilities:

• Manage the daily operations of the claims department, including monitoring claims volume, managing resources, and ensuring the timely and accurate processing of all claims
• Supervise and train a team of claims specialists, ensuring they have the tools, resources, and training necessary to perform their jobs effectively
• Develop and maintain strong relationships with key stakeholders, including providers, customers, and internal departments
• Identify and implement process improvements to increase efficiency and accuracy of claims processing
• Analyze claims data to identify trends and patterns, and make recommendations for improvements to the claims process
• Ensure compliance with all state and federal regulations related to claims processing and adjudication
• Manage the claims appeals process, including reviewing appeals, making determinations, and communicating decisions to members and providers
• Collaborate with other departments, including customer service and finance, to ensure seamless operations across the organization
• Qualifications:
• Bachelor's degree in healthcare administration, business, or a related field preferred
• 5 years of experience in health insurance claims processing and management preferred
• Strong understanding of healthcare billing codes and regulations
• Experience managing a team of claims specialists
• Excellent analytical and problem-solving skills
• Strong communication and interpersonal skills
• Ability to work collaboratively with cross-functional teams
• Knowledge of claims processing software, such as Epic or Cerner, is helpful

If you are a motivated and experienced Health Insurance Claims Manager looking for a challenging and rewarding opportunity, please submit your application today. Wilcox Companies is an equal opportunity employer and welcomes applicants from all backgrounds.