Job Summary
The TL-Claims HC role is pivotal in managing and overseeing claims adjudication processes within the healthcare sector. This position requires a deep understanding of claims and payer domains with a focus on utilizing MS Excel for data analysis and reporting. The candidate will work from home during night shifts ensuring efficient and accurate claims processing to enhance organizational performance.
Responsibilities
- Lead the claims adjudication team to ensure timely and accurate processing of healthcare claims.
- Oversee the implementation of best practices in claims management to improve efficiency and reduce errors.
- Provide expert guidance on complex claims issues leveraging domain knowledge in claims and payer processes.
- Utilize MS Excel to analyze claims data identify trends and generate insightful reports for decision-making.
- Collaborate with cross-functional teams to streamline claims workflows and enhance operational effectiveness.
- Monitor compliance with regulatory requirements and internal policies to maintain high standards of claims processing.
- Develop and maintain documentation of claims procedures and policies for training and reference purposes.
- Facilitate regular training sessions for team members to keep them updated on industry changes and new technologies.
- Drive continuous improvement initiatives to optimize claims adjudication processes and enhance customer satisfaction.
- Ensure effective communication with stakeholders to address queries and resolve issues promptly.
- Implement strategies to minimize claim denials and maximize reimbursement for healthcare services.
- Coordinate with IT teams to integrate advanced tools and technologies for claims management.
- Support the organizations mission by contributing to the efficient handling of claims ultimately benefiting patients and healthcare providers. Qualifications
- Demonstrate proficiency in MS Excel for data analysis and reporting.
- Exhibit strong knowledge of claims adjudication processes and payer domain expertise.
- Possess excellent problem-solving skills to address complex claims issues.
- Show ability to work independently and manage tasks effectively during night shifts.
- Display strong communication skills to liaise with stakeholders and team members.
- Have experience in developing and implementing claims management strategies.
- Demonstrate commitment to maintaining compliance with industry regulations and standards.
Certifications Required
Certified Professional in Healthcare Quality (CPHQ) Advanced Excel Certification
