Manager Claims

2 weeks ago

Macquarie Park, Australia DXC Technology Full time

Essential Job Functions

  • Plans, develops and manages administration of routine to moderately complex claims programs to ensure proper claims policies, practices and procedures are adhered to.
  • Manages and approves small to medium sized billing statements, claims and associated administrative activities to ensure compliance with laws, regulations, policies agreements, and contractual arrangements.
  • Plans and implements procedures to adjust claims when original demographic, sponsor or charge information is in error; monitors and controls resubmission of denials, rejections and appeals.
  • Manages, and as necessary, intercedes with third parties in unusual situations involving payment or adjustment of charges on accounts; consults with departments concerning services which affect collection of charges.
  • Manages, coordinates and prepares periodic reports on department activities including productivity, cash collections, status of accounts receivable, unbilled accounts, allowances, adjustments, related functions, audits and financial reporting.
  • Participates in developing and implementing policies and procedures consistent with those of the organization to ensure efficient and safe operation of the unit.
  • Selects and hires employees. Trains and evaluates employees to enhance their performance, development, and work product. Addresses performance issues and makes recommendations for personnel actions. Motivates and rewards employees including providing salary increases, bonuses and promotions within allocated budgets and company guidelines.
  • Prepares and recommends operating and personnel budgets for approval. Monitors spending for adherence to budget, recommends variances as necessary.

Basic Qualifications

  • Bachelor's degree or equivalent combination of education and experience
  • Bachelor's degree in business administration, insurance or related field preferred
  • Nine or more years of claims experience
  • Five or more years of leadership or supervisory experience
  • Experience working with proper claims handling, policies, and procedures
  • Experience working with computer based analysis tools
  • Experience working with applicable laws, regulations and practices regarding the insurance industry
  • Experience working with insurance and/or medical terminology

Other Qualifications

  • Good organization skills to balance and prioritize work
  • Good analytical and problem solving skills
  • Good communication skills
  • Good human relations skills to select, develop, mentor, discipline and reward employees
  • Good negotiation skills to interact with claimant
  • Ability and willingness to seek out and maintain knowledge of the industry
  • Ability to work independently and lead group activities

Work Environment

  • Office environment

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