Health Claims & Customer Service Manager - Our client has a Direct Hire opening for a managerial position. For consideration, please email resume to jodi.ayers@activatestaffing.com

Health Claims & Customer Service Manager needed for Health Insurance company in Beaverton, OR.

The successful candidate will be:

• Responsible for managing the day-to-day activities of claims and customer service.
• Ensure operations are efficient, effective and compliant.
• Ensure contractual obligations are met, regulatory timeframes are adhered to and customers are provided a high level of service.

Responsibilities:

• Recruit, train develop, supervise and evaluate direct reports
• Ensure performance expectations and standards are conveyed and clearly understood by department staff.
• Evaluate employee's performance by conducting annual performance reviews and periodic performance check-in meetings.
• Ensure staff has the information, tools and resources necessary to perform their jobs
• Responsible for coordination of staff and Claims Department workflows
• Proactively monitor and ensure that the claims department operates in compliance with applicable state, federal and HIPAA requirements while meeting contracted client service agreements.

Requirements:

• Bachelor's degree required
• 5+ years' experience as a health plan/carrier claims or customer service manager.
• Knowledge of state, federal and other regulations as it relates to claims and customer service administration
• In-depth knowledge of claim adjudication principles and procedures
• Prior experience with Medicare and Medicaid programs preferred.

• Experience with QNXT Claims Processing system preferred.

Salary Range:

• $80,000 - $95,000 per year

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