- Responsible for the general coordination of the day-to-day functions of the department.
- Monitoring of the claims pre-logging process, assignment and distribution of claims for adjudication.
- Processing of claims for Family Guardian employees.
- Regular monitoring and analysis of adjudicator productivity ensuring output within expectations and identifying and addressing excess capacity opportunities and/or any unsatisfactory performance concerns.
- Assists with the monitoring, reporting and resolution of pending inventory of outstanding claims & claims production levels.
- Regular analysis of claims data to identify possible opportunities for product/process improvement.
- Provide leadership and coaching to direct reports, ensuring adherence to Company policies & procedures and strict timelines for the submission of reports, etc.
- Assist with any other functions assigned by management.
KNOWLEDGE & SKILLS:
- Bachelor’s Degree or equivalent preferred;
- Minimum 7 years’ experience in claims adjudication and/or claims auditing.
- ACS,ARA,UND,PAHM,ALHC,FLHC,FLMI Designation or Equivalent
- Certified Professional Coder (CPC) Designation
- Knowledge of CPT AND ICD-9/10 coding, and claims adjudication rules and edits
- Must be highly computer literate, especially with Microsoft Office suite of products.
- Ability to communicate effectively, both orally and in writing
- Must possess strong organizational and analytical skills with strong propensity for accuracy.
- Ability to investigate and analyse information, and refer findings appropriately.
- Must exhibit a high level of confidentiality.
Resumes with accompanying certificates should be forwarded via email to email@example.com.
FamGuard thanks all applicants; however, only those short-listed will be contacted.
Claims Supervisor, BahamaHealth