Manager, Claims

Job Description The Manager, Claims implements end to end service model across provider segments and ensures delivery against business targets. The role sets performance and process targets within customer segment(s) to enable high level of claims processing, claims financial processing, and customer service. Manages claims submission, refunds, and recovery from all lines of business for assigned customer segment(s). Collaborates with claims leadership to understand customer segment(s) and contractual obligations. This role is also responsible for claims accounting and financial reporting. What You'll Do Streamline shared processing to reduce management by exception Set operational process to address market trends, BCBSNC capabilities and customer demand Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards. Research and resolve banking issues. Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions. Manage financial recovery activities including refunds and collections Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality Design and develop tools and techniques for improvements. Identifies needed process and procedural changes which will result in improved customer satisfaction. Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPS in collaboration with Sales organization Serve as ASO Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting. Represent Claims Operations to A