Manager,Claims Processing HP

  • Fort Worth, TX
  • Cook Children's Health Plan
  • Claims
  • Full-Time - Days - 8-5
  • Professional/Management
  • Health Plan
  • Req #: 60685
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Position is responsible for managing the personnel and processes of the Claims Processing team. Primary duties include, but are not limited to: 1. Managing the claims inventory and turn-around time in compliance with State contract requirements 2. Hire, train coach and evaluate performance of direct reports 3. Track and report staff metrics to leadership 4. Perform and/or coordinate claims research related to claim issues 5. Develop strategies to maximize auto adjudication and reduce adjustments and appeals 6. Establish and maintain comprehensive departmental policies and procedures 7. Perform audits to monitor efficiency and compliance with policies 8. Professionally communicate and collaborate across all functional areas of the Health Plan

Education & Experience

  • Bachelors degree required, Will substitute 10 years experience for Bachelors Degree.
  • High School diploma or equivalent.
  • 3-5 years supervision experience.
  • Five years’ experience in a medical claims processing environment.
  • Must be extremely detail-oriented, precise, and thorough.
  • Extensive knowledge of medical claim processing procedures and guidelines.
  • Ability to work independently while providing support to a team environment.
  • Extensive knowledge of medical benefits and medical terminology.
  • Must have strong organizational skills, problem solving, and decision making skills.
  • Strong knowledge of claim adjudication and benefit plan application for Texas Medicaid.
  • Knowledge of commercial insurance provisions.
  • Able to process adjustments as needed.
  • Knowledge of Microsoft Office Skills including Word, and Excel.

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.

Additional Information


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