Medical Claims Manager - Military Veterans
at Act One
AppleOne is proud to present:
Hiring a Medical Insurance Claims Manager in the Coral Gables area. This position requires prior management experience. Responsible for leading a team of 7 claims processors.
Duties & Responsibility:
· Manage the claims and repricing departments to ensure proper workflow is conducted. Monitor timelines and constantly communicate via e-mail with clients to follow up on claims handling.
· Review and perform quality assessments of work being released to clients to ensure claims processing errors are kept at a minimum. Identify claims that should be audited by the Medical Team when the total charges exceed the pre-established criteria.
· Implement new procedures for new line of business. Train and cross-train all staff member with the Claims Handling Process and miscellaneous.
· Review & perform periodic quality assessments of work being released to the clients
· Provide clients with daily, weekly and or monthly updates on claims
· Review all rejected claims
· Prepare Eligibility files
· Collaborate and communicate with other departments on claims issues.
· Train new staff, also cross train existing staff
Benefits & Salary
- Medical
- Paid Vacation
- Great Pay up to $75K (depending on experience).
Apply for this great position as a medical claims manager today!
EEO/AA Employer/Vet/Disabled.
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
#1549
Experienced (Non-Manager)
Miami, FL
The ActOne Group is a global leader in the human resources industry that specializes in partnering with firms looking to optimize human resource talent management. For nearly 50 years, we have found success by focusing our energy on three distinct business categories: Workforce Solutions, Staffing Solutions and Business Solutions. Today, The ActOne Group has over 13,000 clients and 2,500 employees located throughout the United States, Canada, Puerto Rico, India, Brazil, South Korea, Germany, Denmark and the United Kingdom. We are a privately-held California corporation that bears the distinction of being the largest zero-debt, woman- and minority-owned workforce management company in the United States. WORKFORCE SOLUTIONS AgileOne combines best-of-breed talent acquisition technology with an experienced managed services team to create a valuable workforce technology solution. We help organizations streamline processes, from the automation of requisitions and time-card management, to supplier relationship support, accurate invoice processing and real-time, customized reporting. STAFFING SOLUTIONS We are one of the Staffing Firms in the U.S. and provide services under these brands: - AppleOne Employment Services - AllSTEM - All's Well Health Care Services - ActOne Executive Search BUSINESS SERVICES - A-Check America - AppleOne Payroll & Tax Filing - CTA Travel - full service travel agency - ActOne Government - ATIMS - AllCare