Claims Manager

San Antonio, TX

Posted: 05/30/2024 Job Number: 21370 Pay Rate: 80000

Job Description

Job Purpose

The Claims Manager is responsible for overseeing and directing delegated Managed Care Claims adjudication and manage our medical claims department.

Essential Job Duties & Responsibilities
  • Participate in inter-departmental business activities, including input into budget preparation
  • Prepare inbound and outbound 835, 837, EFT, etc.
  • Encourage positive staff results by communicating job expectations;planning, monitoring, and appraising results;coaching, counseling, and implementing corrective action plans when necessary;developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
  • Complete performance evaluations in a timely manner.
  • Create, review, and/or update departmental procedures, workflows, and resource material.
  • Implement necessary policy and regulatory changes.
  • Develop and manage auditing and quality control standards.
  • Supervise the coordination of workflow and staffing of day-to-day activities as well as assigning and monitoring work of staff in order to adhere to productivity and quality standards to meet stated goals.
  • Manage delegated claims audit and reporting.
  • Ensure CMS and delegated claims compliance.
  • Resolve and/or gather appropriate guidance for any escalated issues.
  • Other duties, as assigned

  • Minimum 5 years medical claims adjudication working experience, with at least 3 years of managerial experience
  • Medicare guidelines and healthcare claims regulation knowledge
  • Delegated Medicare Advantage Experience is required
  • Experience with claims adjudication software

  • Bachelor’s Degree preferred. In lieu of a degree, 6 or more years of relevant experience

Knowledge, Skills & Abilities
  • Medicare guidelines and healthcare claims regulation knowledge

Work Hours, Travel Requirements
  • Monday –Friday, 8: 00 a.M. –5: 00 p.M., and as needed to complete projects.
  • Travel to medical offices may be necessary for the purpose of providing benefit education.
  • Position is 100% onsite, no remote work offered.


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About San Antonio, TX

Step into a world of career possibilities in San Antonio, Texas! As a vibrant hub of culture, history, and opportunity, this city offers job seekers a unique blend of Texan charm and modern growth. From the iconic Alamo and romantic River Walk to the flavorful Tex-Mex cuisine and thriving arts scene with institutions like the McNay Art Museum and Tobin Center for the Performing Arts, San Antonio has something for everyone. With professional sports teams like the Spurs and a plethora of parks, there's always something exciting to do in this dynamic city. Don't miss out on your chance to explore our job listings and start your career journey in this enchanting region!