Medical Claims Review Manager jobs in Vermont
Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Recently Added Medical Claims Review Manager jobs
Claims Team Manager
- National Life Group
-
Montpelier, VT
FULL_TIME
-
National Life Group
At National Life, do work that matters in a culture where people matter. Join a growing organization where our people have been bringing peace of mind to families and our communities for 175 years.
Claims Team
Our Claims Team is central to serving National Life Group’s ultimate mission of keeping the promises we make to our customers, and we do so with pride, compassion, and a caring heart. As National Life grows, we have an exciting opportunity to create the claims function of the future, and we’re looking for new teammates to help us explore and deliver that vision.
Claims Managers have an opportunity to apply their experience and broad technical skills to advance their insurance careers in a leadership role. At National Life Group, we also offer world-class benefits that extend beyond competitive compensation and health and retirement benefits.
Position Summary
The Claims Team Manager is a newly created position that will share leadership responsibilities for our fast growing living benefits team. Living benefits are an important part of National Life Group’s success, and this individual will report to our Senior Director of Claims and be a key contributor to developing the supporting claim function. The Claims Team Manager is an industry subject matter expert in products, systems, policies, and procedures as well as a leader and developer of our people talent. Managers support our customer facing examiners and are central to creating and delivering seamless service excellence in support of the mission of the business.
Key Responsibilities- Maintain an advanced working knowledge of claims procedures, policies, and system applications, as well as company life and annuity product features
- Drive the execution of team objectives, service delivery, and expectations by planning, organizing, and directing team members
- Participate in strategic planning to develop departmental operational plans to maximize the department's efficiency, productivity, and performance
- Develop an internal talent pipeline, by setting team and individual goals, coaching for performance and individual growth and development
- Partner with stakeholders across the organization to drive large scale initiatives and champion successful change implementation to create value
- Provide claims examiners with ad hoc support for escalations and claims with the highest complexity
- Coordinate with leadership, sales, legal, compliance, reinsurance, underwriting, and actuarial to maintain the contractual provisions and company practices for claim adjudication and to minimize potential litigation
- Mentor and support technical training of examiners and participate in cross-organizational claim education
- Commit to professional growth and development, including participating in industry conferences and maintaining industry relationships
- 10 years of industry experience as a Claims Examiner or Underwriter, preferably in Life, Annuity, Disability, Long Term Care or Health insurance
- 5 years of management experience, with a demonstrated ability to direct others, including developing, training, and executing performance goals.
- A comprehensive understanding of claims appeals, denials, medical terminology, and contract language.
- Exceptional leadership, team management, and interpersonal communication skills.
- Bachelor’s degree preferred, but applicants of various backgrounds are encouraged to apply
- Preferred background includes insurance industry and business process designations such as ALMI, FLMI, ALHC, FLHC, and CLU
- Proficiency with life insurance industry core systems, including claims, enterprise content management, and customer relationship management, as well as collaboration platforms
- Customer focus – deliver the highest standards of quality service through effective and compassionate listening, communication, and responsiveness
- Business and technical acumen – maintain a working knowledge of computer information systems, insurance contract features and regulatory rules, and medical terminology
- Managing and organizing work – clearly assigning responsibilities and expectations, setting objectives and monitoring progress and results
- People development – coordinate the development of claims examiners by coaching, monitoring progress, and providing feedback
- Building effective teams – bringing together a mix of skillsets and fostering team cohesiveness to create a group that is stronger than the sum of the individuals
- Data analysis – applying broad knowledge and perspective to articulate insights into business results
- Organizational agility – understand cross-functional operations and leverage relationship network
- Critical thinking – apply judgment and exercise sound reasoning to make and support claim decisions
Other rewards may include an annual bonus, quarterly bonuses, commissions, and other long-term incentive compensation, depending on the position. National Life offers a competitive total rewards package which includes: a 401(k) retirement plan match; medical, dental, and vision insurance; a company funded wellness account for director and below employees; 10 paid holidays; a generous paid time off plan (22 days of combined time-off for non-exempt employees and exempt employees have discretion in managing their time, including scheduling time off in the normal course of business, but in no event will exempt employees receive less sick time than required by state or local law); 6 weeks of paid parental leave; and 6 weeks of paid family leave after a year of full-time employment.
National Life is accepting applications for this role on an ongoing basis and the role remains open until filled.
National Life Group® is a trade name of National Life Insurance Company, Montpelier, VT – founded in 1848, Life Insurance Company of the Southwest, Addison, TX – chartered in 1955, and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. Life Insurance Company of the Southwest is not an authorized insurer in New York and does not conduct insurance business in New York. Equity Services, Inc., Member FINRA/SIPC, is a Broker/Dealer and Registered Investment Adviser affiliate of National Life Insurance Company. All other entities are independent of the companies of National Life Group.
National Life Group
1 National Life Dr
Montpelier, VT 05604
Social Media Policy
Site Disclosure and Privacy Policy - 9 Days Ago
Property Claims Manager
- Union Mutual of Vermont Companies
-
Montpelier, VT
FULL_TIME
- Union Mutual is looking for a professional and experienced Property Claims Manager to join our dynamic team of Claims professionals based in our Montpelier, Vermont office. The Company will consider r...
- 20 Days Ago
Account Services Review Specialist
- New England Federal Credit Union
-
South Burlington, VT
FULL_TIME
- Position: Account Services Review Specialist Location: 88 Technology Park Way, South Burlington, VT Hours: Monday-Friday, 8:30am-5:00pm & 9:30am-6:00pm Position description: The Account Review Special...
- 10 Days Ago
Travel Nurse RN - Case Manager in Barre, VT
- OneStaff Medical
-
BARRE, VT
FULL_TIME
- Case Management Nurses coordinate long-term care for their patients. Their goal is to treat their patients at optimal times to keep them healthy and out of the hospital. As a Case Management Nurse, yo...
- 6 Days Ago
OR RN Manager
- Southwestern Vermont Medical Center
-
Bennington, VT
FULL_TIME
- Southwestern Vermont Medical Center seeks an experienced Lead Operating Room Registered Nurse to provide patient care and coordination in the Operating Room. The Lead RN will work closely with the Dir...
- 3 Days Ago
Risk Manager
- Northwestern Medical Center
-
St Albans, VT
FULL_TIME
- Join our award-winning team!Northwestern Medical Center, where you can be the difference!Looking to advance your career at a vibrant, community hospital in a locale that will have you wondering why yo...
- 4 Days Ago
Medical Claims Review Manager jobs at Popular Companies
Hospital Medical Leader
- Petco
-
Fairfield, CA
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 6/10/2024 12:00:00 AM
Hospital Medical Leader
- Petco
-
Deerfield Beach, FL
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 6/9/2024 12:00:00 AM
Hospital Medical Leader
- Petco Animal Supplies Inc
-
Noblesville, IN
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 6/9/2024 12:00:00 AM
Head of Medical Writing
- Barrington James
-
- Clinical-stage biopharmaceutical company in San Francisco, is seeking a Head of Medical Writing. This leadership role in...
- 6/8/2024 12:00:00 AM
Head of Medical Strategy
- ExecuSearch
-
Atlanta, GA
- The Head of Medical Strategy provides medical expertise to the rheumatology commercial and medical teams and provides cl...
- 6/8/2024 12:00:00 AM
Head of Medical Strategy Rheumatology
- UCB
-
Atlanta, GA
- Make your mark for patients The Head of Medical Strategy provides medical expertise to the rheumatology commercial and m...
- 6/8/2024 12:00:00 AM
Head of Medical Writing
- Barrington James
-
San Francisco, CA
- Head of Medical Writing - Rare disease Biotech We are currently partnered with a growing, west coast based biotech focus...
- 6/7/2024 12:00:00 AM
Hospital Medical Leader
- Petco Animal Supplies, Inc.
-
Plainview, NY
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 6/7/2024 12:00:00 AM
About Vermont
Vermont is located in the New England region of the Northeastern United States and comprises 9,614 square miles (24,900 km2), making it the 45th-largest state. It is the only state that does not have any buildings taller than 124 feet (38 m). Land comprises 9,250 square miles (24,000 km2) and water comprises 365 square miles (950 km2), making it the 43rd-largest in land area and the 47th in water area. In total area, it is larger than El Salvador and smaller than Haiti. It is the only landlocked state in New England, and it is also the easternmost and the smallest in area of all landlocked sta...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$96,161 to $122,608
Most Popular Cities in Vermont for Medical Claims Review Manager Jobs
What does a Medical Claims Review Manager do?
Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiners view of a particular bills status in a claim records related bill screen, or a bill review analysts view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019