Mid-Level Operations Manager
Description
- Supervises staff of enrollment and eligibility clerks; distributes work, ensures work is completed and provides guidance and direction to team
- Utilizes electronic health information imaging and inputs enrollment recommendations into electronic database module.
- Reviews and processes appeals requests, makes recommendations to the customer
- Tracks and records work production and reports results to management
- Makes clinical review judgment decisions based on clinical experience when applicable.
- Plans and implements procedures for enrollment and eligibility
Qualifications
- Bachelor's degree or equivalent combination of education and experience
- Bachelor's degree in business administration, insurance or related field preferred
- Four or more years of claims experience
- Two or more years of leadership experience included
- Experience working with proper claims handling, policies and procedures
- Experience working with computer based analysis tools
- Experience working with insurance and/or medical terminology
- Organizational skills to balance and prioritize work
- Analytical and problem solving skills
- Communication skills
- Human relations skills to select, develop, mentor, discipline and reward employees
- Negotiation skills to interact with claimant
- Ability to understand and convey applicable laws, regulations and practices regarding the insurance industry
- Ability to work independently and lead group activities
March 23, 2011
• Tags: Healthcare Preferred Job in Lanham, Maryland Us, Mid-Level Operations Manager • Posted in: General