Manager I, Claims Services
Core
Overseeing pre-approval medical services (cashless claims), managing junior case reviews, and establishing medical cost/quality control guidelines.
Role type
Manager I, Claims Services
Builds
Optimized claims processing workflows and medical cost/quality standards
Domain
Life insurance, healthcare administration
Required skills
Pre-approval medical claims management, complex claim adjudication, TPA relationship management, medical cost control, regulatory compliance, team leadership, data analysis, medical terminology knowledge
Preferred skills
Quality assurance experience, knowledge of insurance regulatory requirements
Responsibilities
Manage pre-approval medical claims to ensure timely and accurate claim settlements, Handle complex and high-value claims, Develop medical cost and quality control standards, Provide guidance and training to junior claims assessors, Ensure compliance with regulatory requirements, Collaborate with TPAs to resolve claims-related issues
Seniority
Manager I, 5+ years experience