The Medical Claims Manager is responsible for overseeing the end-to-end medical claims process to ensure accuracy, compliance, and timely resolution. This role manages claims staff, coordinates with providers and payers, resolves escalated issues, and ensures adherence to regulatory and organizational standards.

Key Responsibilities

• Oversee daily operations of medical claims processing, including professional and institutional claims
• Manage, train, and support claims staff to ensure productivity and quality standards are met
• Review and resolve complex, denied, or escalated claims issues
• Ensure compliance with HIPAA, CMS, payer guidelines, and internal policies
• Monitor claim turnaround times, accuracy rates, and performance metrics
• Collaborate with billing, coding, compliance, and customer service teams
• Serve as a liaison with insurance carriers, payers, and third-party administrators
• Analyze claim trends and implement process improvements to reduce denials and rework
• Develop and maintain claims policies, procedures, and training documentation
• Prepare reports related to claims volume, aging, denials, and recoveries
• Address provider and internal inquiries regarding claim status and reimbursement
• Stay current on regulatory changes impacting medical claims processing

Qualifications

• 3-5+ years of experience in medical claims processing or medical billing
• Prior leadership or supervisory experience preferred
• Strong knowledge of CPT, ICD-10, HCPCS, EOBs, and payer guidelines
• Experience with claims management systems and EHR/PM software
• Excellent analytical, organizational, and problem-solving skills
• Strong communication and leadership abilities

Compensation & Schedule

• Job Type: Full-time
• Pay Range: $30.00 - $38.00 per hour