Medical Claims Review Manager jobs in Alaska

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)

P
Senior Claims Insurance Manager - Medical Professional Liability Claims *Remote
  • Providence Health
  • Alaska, AK FULL_TIME
  • Description

    Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

    Providence is calling a Senior Claims Insurance Manager - Medical Professional Liability Claims Handler who will:

    • Be responsible for medical professional liability claims and complex general liability claims in accordance with the System's claims program policies and procedures and within an assigned Region or scope of responsibility
    • Analyze insurance policy documents to address coverage
    • Work with defense attorneys specializing in defense of medical negligence claims
    • Be responsible for writing insurance policy coverage letters
    • Be responsible for investigating, evaluating and managing professional and other liability claims against the organization
    • Maintain up-to-date and accurate claim files, including summaries, action plans, and claims status in the claims data management software
    • Communicate directly with patients, claimants, witnesses and families
    • Coordinate with facility leadership, risk managers, defense counsel, and others
    • Monitor and advise on disclosure and early resolution opportunities
    • Ensure compliance with relevant claims reporting procedures and required regulations
    • Provide feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate System risk management issues
    • Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists

    This role is considered to be a remote position and can be worked from the majority of States within the United States.

    Please note Providence cannot hire within the following States:

    • Colorado
    • Hawaii
    • Massachusetts
    • New York
    • Ohio
    • Pennsylvania

    Required qualifications for this position include:

    • Bachelor's Degree in Business Administration, Finance, or another related discipline -OR- a combination of equivalent education and experience
    • 7 years relevant general and professional liability claims processing or management experience
    • 5 years direct supervisory or management experience

    Preferred qualifications for this position include:

    • Experience handling Medical Negligence Professional Liability Claims
    • Experience handling Complex General Liability Claims
    • Experience Investigating, evaluating and negotiating medical negligence claims
    • Experience working with defense attorneys specializing in defense of medical negligence claims
    • Experience analyzing medical professional and general liability insurance policy documents and addressing coverage
    • Experience writing medical professional and general liability insurance policy coverage letters
    • STARS / Riskonnect or similar claims management software experience
    • Certified Professional Healthcare Risk Management (CPHRM)

    Salary Range by Location:

    WA: (Puget Sound, Vancouver), OR: (Portland), AK: (Anchorage):

    • Min: $51.16
    • Max: $82.36

    OR: (Salem, Hood River, Medford, Seaside):

    • Min: $47.70
    • Max: $76.78

    E-WA: (Richland, Spokane, Walla Walla):

    • Min: $45.53
    • Max: $73.29

    NorCal (Napa, Sonoma):

    • Min: $59.84
    • Max: $96.32

    SoCal, NorCal (Humboldt), AK: (Kodiak, Seward, Valdez), NV:

    • Min: $53.33
    • Max: $85.85

    MT:

    • Min: $41.19
    • Max: $66.31

    TX, NM:

    • Min: $39.02
    • Max: $62.82

    Why Join Providence?

    Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

    About Providence

    At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

    The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

    Check out our benefits page for more information about our Benefits and Rewards.

    About the Team

    Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

    Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

    Requsition ID: 264545

    Company: Providence Jobs

    Job Category: Financial Transactions

    Job Function: Health Plans Services

    Job Schedule: Full time

    Job Shift:

    Career Track: Business Professional

    Department: 4008 SS RIS

    Address: WA Renton 2001 Lind Ave SW

    Work Location: Providence Southgate 2-Renton

    Pay Range: $53.33 - $85.85

    The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

    Check out our benefits page for more information about our Benefits and Rewards.

  • 1 Month Ago

N
UTILIZATION REVIEW MANAGER
  • North Star Behavioral Health
  • Anchorage, AK FULL_TIME
  • Responsibilities: UTILIZATION REVIEW MANAGER OPPORTUNITY North Star Behavioral Health, Alaska's premier mental health facility, is on a mission to provide hope and healing to individuals facing psychi...
  • 28 Days Ago

B
RN Case Manager - Utilization Review
  • Bartlett Regional Hospital
  • Bartlett, AK PART_TIME
  • This recruitment is open until filled. Bartlett Regional Hospital is searching for a RN Case Manager to join our Case Management team! This position is eligible for relocation assistance of up to $10,...
  • 1 Month Ago

A
Medical Claims Specialist I, II, III - (Salary: DOE)
  • Alaska Native Tribal Health Consortium
  • Anchorage, AK FULL_TIME
  • The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partners...
  • 22 Days Ago

A
Medical Claims Specialist II - Purchased Referred Care - Closes: 10/04/2022
  • Alaska Native Tribal Health Consortium
  • Anchorage, AK FULL_TIME
  • The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partners...
  • 15 Days Ago

A
Territory Manager
  • Arctoa Medical
  • , AK FULL_TIME
  • Job Title: Territory Manager Location: Alaska Terms: Full Time Salary/rate: $45,000 / year Uncapped Commission. $90k-$110k first year at plan. Requirements: Available to travel occasionally for work. ...
  • 26 Days Ago

A
Head of Medical Writing
  • Aerovate Therapeutics Inc.
  • Waltham, MA
  • Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
  • 4/26/2024 12:00:00 AM

P
Veterinarian - Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Montclair, NJ
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 4/26/2024 12:00:00 AM

H
Regional Medical Lead
  • HeartFlow, Inc
  • New York, NY
  • HeartFlow, Inc. is a medical technology company advancing the diagnosis and management of coronary artery disease, the #...
  • 4/26/2024 12:00:00 AM

P
US Pneumococcal Adult Medical Lead, MD
  • Pfizer
  • New York, NY
  • ROLE SUMMARY Provide pneumococcal franchise leadership on behalf of Asset Medical Affairs team. * Collaborates with Bran...
  • 4/26/2024 12:00:00 AM

I
Medical Director, Medical Management
  • Imperial Health Plan Of California Inc.
  • Pasadena, CA
  • People are the most important asset of Imperialfor this reason the difference and plurality of people, equality of oppor...
  • 4/26/2024 12:00:00 AM

A
Head of Medical Writing
  • Aerovate Therapeutics, Inc.
  • Waltham, MA
  • Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
  • 4/25/2024 12:00:00 AM

B
Assistant-Certified Medical Lead
  • Baptist Memorial
  • Memphis, TN
  • Summary Provides personal care assistance to patients under the direction of licensed personnel and /or Administrator. P...
  • 4/25/2024 12:00:00 AM

P
Hospital Medical Leader
  • Petco
  • Baldwin, NY
  • Create a healthier, brighter future for pets, pet parents and people!If you want to make a real difference, create an ex...
  • 4/23/2024 12:00:00 AM

Alaska is the northernmost and westernmost state in the United States and has the most easterly longitude in the United States because the Aleutian Islands extend into the Eastern Hemisphere. Alaska is the only non-contiguous U.S. state on continental North America; about 500 miles (800 km) of British Columbia (Canada) separates Alaska from Washington. It is technically part of the continental U.S., but is sometimes not included in colloquial use; Alaska is not part of the contiguous U.S., often called "the Lower 48". The capital city, Juneau, is situated on the mainland of the North American ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$106,256 to $135,478

Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiner’s view of a particular bill’s status in a claim record’s related bill screen, or a bill review analyst’s view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019