Health Claims Manager

Job Description

This role offers the opportunity to be part of a collaborative and mission-driven organization, along with a highly competitive benefits package, including:

• 100% employer-paid medical, dental, and vision coverage
• 100% employer-funded HRA
• 100% employer-funded pension and annuity

*** The only deductions taken from your check are taxes***

• Oversee daily operations of the claims processing unit for health benefit programs, ensuring timely and accurate adjudication of claims.
• Supervise and provide leadership to claims staff, including hiring, training, performance evaluations, and workflow management.
• Monitor and analyze claims processing metrics and trends to ensure productivity and compliance with regulatory and policy standards.
• Develop and implement policies and procedures to improve operational efficiency and accuracy in claim adjudication.
• Coordinate audits and reviews of claims to ensure quality control and compliance with plan documents, contracts, and applicable laws (e.g., ERISA, HIPAA, ACA).
• Serve as a subject matter expert on claims adjudication, resolving complex or escalated claim issues and appeals.
• Collaborate with IT and Bridgeway to maintain system integrity and enhance claims processing capabilities.
• Provide reporting and analytics to senior management on claims trends, costs, denial rates, and performance metrics.
• Stay up to date with industry’s best practices, regulatory changes, and innovative technologies in health claims administration.
• Other duties as assigned.

• Bachelor’s degree in Health Administration, Business, Finance, or related field or a minimum of 10 years of experience in health benefits claims processing, with at least 5 years in a supervisory or managerial role.
• Strong knowledge of medical terminology, ICD/CPT coding, and healthcare reimbursement methodologies.
• Familiarity with health insurance regulations, including HIPAA, ACA, and ERISA.
• Excellent leadership, organizational, and critical thinking skills.
• Proficiency in claims processing systems and Microsoft Office Suite.
• Effective communication and interpersonal abilities.
• Ability to analyze data and prepare detailed reports.

• Experience collaborating with Blue Cross & Blue Shield & Bridgeway

No calls or agencies please. Mid-America Carpenters Benefits will only employ those who are legally authorized to work in the United States. This is not a position for which sponsorship will be provided. Individuals with temporary visas such as E, F-1, H-1, H-2, L, B, J, or TN or who need sponsorship for work authorization now or in the future, are not eligible for hire.

Mid-America Carpenters Benefits is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, religion, national origin, age, marital status, political affiliation, sexual orientation, gender identity, genetic information, disability, or protected veteran status. We are committed to providing a workplace free of any discrimination or harassment.