Manager I, Claims Services
Core
Manage pre-approval medical claims (cashless claims) and oversee junior case reviews to ensure timely and accurate settlements.
Role type
Manager I, Claims Services (Life Insurance)
Builds
Pre-approval medical claims processing and medical cost/quality control guidelines
Domain
Life Insurance / Healthcare Administration
Required skills
Medical claims management, Leadership, TPA relationship management, Data analysis, Regulatory compliance, Medical terminology knowledge
Preferred skills
Quality assurance experience, Complex claim adjudication
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 issues and improve processes