Manager, Claims

WHO IS GUIDEHEALTH? 

At Guidehealth, our mission is to enhance healthcare affordability for patients and restore the fulfillment of practicing medicine for providers. As a physician-led company, we recognize that streamlining administrative tasks and harnessing the power of predictive analytics and AI enable our partner physician practices prioritizing delivering high-quality healthcare focused on outcomes and value. 

Driven by empathy, we empower physicians to anticipate the needs of patients requiring more attention, strengthen connections between patients and physicians with virtually-embedded Healthguides, and leverage AI and analytics to proactively avoid preventable events. This approach results in increased levels of patient and practice engagement, ultimately leading to more significant positive impacts on patients. 

Join us as we put healthcare on a better path!!  

As a Manager of the Claims Department, you will lead your staff to an exceptional performance level by giving quality objectives and opportunities to expand their knowledge of services, products, and troubleshooting techniques which will focus on improving performance and processes to better support customers and internal department procedures. 

WHAT YOU’LL BE DOING  

• Determining the claims departments operational strategies by conducting needs assessments, capacity planning, and cost/benefit analyses; identifying and evaluating state-of-the-art technologies; defining user requirements; establishing technical specifications, and production, productivity, quality, and claims processing standards; contributing information and analysis to organizational strategic plans and reviews with standard claims processing performance metrics. 
• Maintaining and improving claims processing operations by monitoring system performance; identifying and resolving problems; preparing and completing action plans; managing system and process improvement and quality assurance programs. 
• Assessing and assigning workflow, coaching, counseling, and disciplining employees; administering scheduling systems and processes; communicating job expectations; planning, monitoring department measures, conducting staff performance conversations; enforcing policies and procedures. 
• Completing monthly reporting submission requirements as outlined by the Health Plan. 
• Completing client reporting requirements.  
• Coordinating operational activities with other internal functions alongside departments and managers. 
• Conducting at minimum monthly meetings with staff and attend operational meetings as requested. 
• Attending client facing meetings as requested to discuss department statistics and measures. 
  

WHAT YOU'LL NEED TO HAVE

• 3-5 years of supervisory or management experience in healthcare claims  
• Claims processing experience. 
• CPT and ICD coding knowledge. 
• Proficient with Microsoft programs (Word, Excel and Access) at an intermediate to advanced level.  
• Must be organized, self-motivated, detail oriented, disciplined and a team player 
• Demonstrates the ability to manage staff and multi-task with minimum supervision and the ability to prioritize appropriately.   
• Ability to meet deadlines and prioritize tasks; to effectively interact with operational and clinical personnel; collect, correlate, and analyze data 
• Excellent written and oral communication. 
  

WHAT WE WOULD LOVE FOR YOU TO HAVE

• HMO Managed care Medicare Advantage experience. 
• Coding certificates.  
• Microsoft Access experience level – Advanced. 
  

COMPENSATION 

Guidehealth’s compensation structure includes more than just base salary. We believe in providing world-class benefits including comprehensive medical, dental, and vision plans, long and short-term disability, life insurance, and a 401k plan with a generous match. Our paid time off program includes paid holidays and flexible time that focuses on meeting the demands of the position and our clients, while providing the balance that our employees need. 

The base pay range for this role is between $65,000.00 and $70,000.00 per year, paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications. 

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.  

This position is responsible for following all Security policies and procedures in order to protect all PHI under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager.