Competitive salary range of $180,000 to $200,000 per year

Monday through Friday Schedule

Comprehensive benefits include fully paid medical, dental, and 401(k) with 3% profit sharing.

Cornerstone Staffing Solutions is seeking an experienced Claims division manager to lead a dedicated team for our progressive client. This leadership role offers the opportunity to oversee critical claims operations and drive performance improvements in a highly visible position.

Position Overview:

As Claims Division Manager, you will lead and supervise a team of 14 claims examiners and will be responsible for maintaining high-quality standards, HIPAA compliance, and timely claims processing. You will supervise and manage claims operations, including evaluation, adjudication, auditing, reports, appeals, and customer service, while ensuring compliance with company policies and regulations.

Key Responsibilities:

Oversee claims processing operations, ensuring accuracy and compliance.

Ensuring accuracy by conducting thorough investigations and audits to resolve claim discrepancies
Manage team performance, training, and disciplinary actions.
Interpret plan benefits and guide the department in processing claims.
Collaborate with IT to resolve system issues and implement process improvements.
Lead the preparation and distribution of reports, appeals, and medical review letters.
Provide expert customer service, resolving complex claims issues and communicating with providers and plan participants.

Requirements:

Bachelor’s in a related field (preferred), with 10+ years of management experience in claims processing.
Strong knowledge of group benefit plans, claims adjudication, medical terminology, and claims codes (ICD-10, CPT, HCPCS).
Supervise customer service as an expert regarding eligibility and benefit plans accurately communicating, documenting, and training.
Experience with PPO guidelines, Medicare, and supplemental plan benefits.
Proficiency in claims processing systems (Anthem Blue Cross) and Microsoft Office.
Excellent leadership, communication, and problem-solving skills.
Ability to adapt to change and thrive in a fast-paced environment.
Technologically savvy in resolving issues relating to processing, troubleshooting and editing Anthem Blue Cross systems.
Collaboration with IT and cross-functional teams to troubleshoot, implement and optimize claims systems

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Cornerstone Staffing Solutions, Inc.

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Claims Division Manager