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The Goodwin group
Austin, TX, United States
To Apply for this Job Click Here Our client, a family-owned and run MGA is looking to add a Yacht Claims Manager to its rapidly growing organization. Yacht Claims Manager Benefits Health insurance, dental, vision 401K + 3% match Unlimited PTO Competitive salary + significant bonus/commission potential (OTE $130-200K+) Yacht Claims Manager Requi
Job Source: The Goodwin groupAbbott
Austin, TX, United States
Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues serve people in more than 160 countries.D
Job Source: AbbottMiraval Austin Resort and Spa
Austin, TX, United States
Join us for this incredible opportunity to be part of our team as a Miraval Austin: Event Planning Manager at Miraval Austin Resort and Spa located in Austin, Texas. Full-timeopportunities available ! Not only will you be part of a rock-star team, but you will also get to be part of a team that won North America's Best Resort Spa and Texas' Bes
Job Source: Miraval Austin Resort and SpaCurative Inc
Austin, TX, United States
Curative is reimagining health insurance - with $0 out of pocket costs and by reducing barriers to people seeking care. Help us create a better healthcare experience for our members by making it easy & intuitive for them to access the care they need. We believe in a clear, simple health plan that allows our members to get zero-cost in-network care
Job Source: Curative IncValid8 Financial, Inc.
Austin, TX, United States
Curative is reimagining health insurance - with $0 out of pocket costs and by reducing barriers to people seeking care. Help us create a better healthcare experience for our members by making it easy & intuitive for them to access the care they need. We believe in a clear, simple health plan that allows our members to get zero-cost in-network care
Job Source: Valid8 Financial, Inc.Confidential Jobs
Austin, TX, United States
Healthcare and Health Plan operations | Unable to Sponsor We are looking for a Project Manager (Remote eligible) able to work on EST time zone and spearhead implementations for our Healthcare clients. This is a permanent employee role for someone who is experienced with project planning for end-to-end delivery, including kickoffs, milestones, mana
Job Source: Confidential JobsConfidential Jobs
austin, tx
Healthcare and Health Plan operations | Unable to Sponsor We are looking for a Project Manager (Remote eligible) able to work on EST time zone and spearhead implementations for our Healthcare clients. This is a permanent employee role for someone who is experienced with project planning for end-to-end delivery, including kickoffs, milestones, mana
Job Source: Confidential JobsTuro
Austin, TX, United States
Turo is the world’s largest car sharing marketplace where you can book the perfect car for wherever you’re going from a vibrant community of trusted hosts across the US, UK, Canada, Australia, and France. Whether you're flying in from afar or looking for a car down the street, searching for a rugged truck or something smooth and swanky, Turo puts y
Job Source: TuroAustin, TX, United States
Overview:
As the Claims Manager for Sendero Health Plan, a Health Maintenance Organization (HMO), and other Health Plans based in Texas, you will oversee the efficient and accurate processing of healthcare claims while ensuring compliance with regulatory requirements and company policies. Your leadership will be vital in managing a team of claims specialists, fostering a culture of excellence, and optimizing processes to enhance customer satisfaction.
Responsibilities:
Claims Processing Oversight: Supervise the end-to-end claims processing operations, including intake, adjudication, and payment processes, to ensure accuracy, timeliness, and compliance.
Team Leadership: Recruit, lead, mentor, and motivate a team of claim specialists to achieve performance targets, resolve complex issues, and maintain high productivity levels.
Quality Assurance: Implement and enforce quality assurance measures to uphold accuracy and consistency in claims processing, including regular audits and feedback mechanisms.
Compliance Management: Coordinate with the Compliance Department to stay abreast of federal and state compliance regulations governing the claims processing in the health plan industry, ensuring adherence to all legal requirements and company policies.
Provider Relations: Collaborate with the network providers and with the Sendero Network Team to resolve claims related inquiries, disputes, and grievances, fostering position relationships, and promoting efficient communication channels.
Performance Analysis: Analyze claims data and performance metrics to identify trends, root causes of errors, and opportunities for process improvement, implementing corrective actions as needed.
System Enhancements: Partner with IT teams to evaluate, test, and implement system enhancements or updates to streamline claims processing workflows and enhance system functionality.
Client Services: Ensure exceptional client service standards by promptly addressing inquiries, escalations, and complaints related to claims processing, striving to achieve high levels of member satisfaction. Prepare and review weekly claims reports with Clients to ensure accurate claim adjudications.
Essential Functions
Vendor Coordination: Coordinate with outside vendors to ensure their resources are managed to meet standards of operations for their contracted services.
Training and Development: Develop and deliver training programs for claims staff to enhance their technical skills, regulatory knowledge, and customer service abilities, fostering a culture of continuous learning and professional development.
Resource Management: Manage departmental budget, allocate resources effectively, and make strategic decisions to optimize operational efficiency and cost effectiveness.
Qualifications:
High School Diploma or equivalent Required
Bachelor's Degree Preferred
Work Experience
5 years Management or Supervision of a Health Plan Claims Department Required and
7 years Health Plan Claims Processing Required
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Health Plan Claims Manager jobs in Austin, TX, United States
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