Claims Manager

Job Location:

Fresno Claims Office - Fresno, CA, Position Type:
Full Time, Salary Range: $72384.00 - $78000.00

Hourly, Job Category:
Management, Delta Health Systems (DHS), one of the nation’s leading Third Party Administrators (TPAs) for self-funded health plans, is seeking an experienced and collaborative leader to join our team as Claims Manager. This position oversees day-to-day operational functions for our Stockton and Fresno offices and plays a key role in driving operational excellence, team development, and customer satisfaction.

• Supervise assigned staff in a responsible manner including training, planning, directing work, appraising performance, rewarding, and addresses complaints.
• Mentors, educates, and provides corrective action, performance improvement plans, and disciplines staff when necessary.
• Participants in the interview process for the hiring of new staff when necessary.
• Conducts monthly 1:1, quarterly, and annual performance reviews with staff to discuss productivity, issues, concerns, quality, and expectations.
• Responds to staff, internal and external customer inquiries, and provides resolution to issues accordingly.
• Evaluates department performance and takes corrective action, when necessary,
• Ensures overall inventory and assigned queues and processes are handled within department guidelines.
• Reviews department reports for accuracy, thoroughness, and timeliness and adjusts measurements when necessary.
• Interprets plan provisions and make recommendations for system administrative improvements to meet customer expectations.
• Develop relationships with other departments to ensure interdepartmental communication is effective.
• Develops and maintains effective relationships with customers and their affiliated partners.
• Manages within established budget of unit.
• Collaborates with information services on system enhancements, providing documentation and justification for improvements to system for proper claims flow.
• Assists Client Services with client requests to meet customer expectations, requests, and deadlines.
• Participate in new business implementations.
• Enforces, adheres to, and follows department policies and procedures and Collective Bargaining Agreements.
• Participates in and contributes to department meetings and continual training.
• Represents company at existing and prospective customer meetings.
• Upholds and exemplifies company values.
• Must occasionally travel to client locations.
• Performs other duties as assigned.

• Two to four years of management and claims experience.
• Must be computer literate w/proficiency in spreadsheet and word processing applications.
• Excellent written and verbal communication skills.
• Must have excellent leadership abilities and interpersonal skills; ability to establish confidence, rapport and foster cooperative relationships with clients, providers, and co-workers.
• Must understand self-funded payer claims policies as well as Federal, State and other regulations pertaining to health insurance claims payment including TPL, COB, and coding and reimbursement methodologies.
• Experience with automated claims systems; and ability to maintain sound production operations also required

This position reports directly to a Stockton Claims Manager, limited supervision with considerable responsibility for work quality and quantity.