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Claims Processing Manager Jobs in Rhode Island (NOW HIRING)

Gainwell Technologies

NC · On-site

$126K/yr

What we're looking for • 12+ years of experience in Product Management, Software Development ... of payer operations, claims processing, regulatory requirements, and healthcare technology ...

Brown University Health

Claims Follow Up Rep

Providence, RI · On-site +1

$19.97 - $32.96/hr

... re-process all denied claims to obtain timely reimbursement of each third-party claim and ensure ... Manager will approve work arrangements. MINIMUM QUALIFICATIONS BASIC KNOWLEDGE Equivalent to a high ...

Brown University Health

Claims Follow Up Rep

Providence, RI · On-site +1

$19.97 - $32.96/hr

... re-process all denied claims to obtain timely reimbursement of each third-party claim and ensure ... Manager will approve work arrangements. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: * Equivalent to a ...

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All JobsClaims Processing JobsClaims Processing Manager JobsClaims Processing Manager Jobs in Rhode Island

Claims Processing Manager information

See Rhode Island salary details

$34.3K

$86K

$136.1K

How much do claims processing manager jobs pay per year?

As of Aug 7, 2026, the average yearly pay for claims processing manager in Rhode Island is $86,043.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,600.00 and $102,800.00 per year, depending on experience, location, and employer.

What are the primary challenges faced by a claims processing manager, and how can they be addressed?

Claims Processing Managers often navigate challenges such as ensuring timely and accurate claim adjudication, managing a team with varying workloads, and staying up to date with regulatory changes. Balancing efficiency with compliance requires strong organizational skills and effective communication. Successful managers foster a collaborative environment, implement regular training, and leverage technology to streamline processes, all while maintaining high standards of customer service and data integrity.

What does a claims processing manager do?

A Claims Processing Manager oversees the team responsible for reviewing, evaluating, and processing insurance claims. Their duties include ensuring claims are handled efficiently and accurately, developing procedures to improve workflow, and maintaining compliance with industry regulations. They also resolve complex or escalated claims issues, provide staff training, and report on performance metrics. The role requires strong leadership, analytical skills, and attention to detail to ensure a fair and timely claims process.

What are the key skills and qualifications needed to thrive as a claims processing manager?

To thrive as a Claims Processing Manager, you need expertise in insurance claims procedures, analytical skills, and a solid understanding of regulatory compliance, often supported by a bachelor's degree and relevant industry experience. Familiarity with claims management software, workflow automation tools, and data analysis systems is typically required. Strong leadership, attention to detail, and effective communication are crucial soft skills that set top performers apart in this role. These abilities ensure accurate and efficient claims processing, regulatory adherence, and effective team management, all of which are vital for organizational success.
What are the most commonly searched types of Claims Processing jobs in Rhode Island? The most popular types of Claims Processing jobs in Rhode Island are:
What cities in Rhode Island are hiring for Claims Processing Manager jobs? Cities in Rhode Island with the most Claims Processing Manager job openings:
Claims Processing Manager jobs near you

Claim Auditor Payment Integrity (44544)

Neighborhood Health Plan of Rhode Island

Smithfield, RI • Remote

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

The Claim Auditor in Payment Integrity will address problematic and complex audit assignments to identify claim overpayments in accordance with established billing and coding parameters. Claim payment accuracy will be recognized through sound audit review methods and practices, including but not limited to; claim payment evaluation, medical chart review, claim payment data analysis and assessment of established organizational contractual parameters. Independently analyzes, extracts, refines, and interprets claims data for actionable insights. The Auditor uses self-directed, decision making and problem solving that directly impacts financial outcomes and results.

Duties and Responsibilities:

Responsibilities include, but are not limited to:

  • Investigate potential over-utilization by performing audits thought pre and post claim payment.
  • Initiate and verify claims adjustments, maintain audit documentation, and prepare savings reports.
  • Identify new audit areas through data mining and performing sample audits.
  • Develops reports and deliverables for management and communicates with all levels of stakeholders.
  • Provide recommendations and collaborate with Payment Integrity team on audit outcomes, identified issues, recommended modifications to clinical medical policies, billing and reimbursement guidelines, and online provider manual.
  • Serve as contact with all operational areas relevant to Payment Integrity audit decisions.
  • Represent company in internal and external meetings/conference calls when needed to discuss audit results or perform coding education.
  • Performs other duties as assigned

Qualifications

Required:

  • Associate’s degree or equivalent of three (3) years of claim review work experience to equate to the degree
  • Experience in medical records review, claims processing or utilization/case management in clinical practice or managed care organization
  • Fundamental knowledge of Medicare/Medicaid Guidelines
  • Experience with provider payment methodologies
  • Critical thinking and judgment/decision making skills
  • Solutions oriented-positive attitude
  • Independent problem solving-innovative thinker
  • Strong communication skills (written/verbal)
  • Excellent Customer Service skills
  • Ability to effectively prioritize and execute tasks in a high-pressure environment
  • Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)
  • Ability to work independently as well as part of a team

Preferred:

  • American Academy of Professional Coder’s (AAPC) COC and/or CIC
  • Data analytics experience
  • Knowledge of COGNOS reporting environment

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.  

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