Claims Manager
Impresiv HealthUnited States2 days ago
Job type
- Full-time
Job descriptionManage and oversee daily claims processing operations, ensuring compliance with CMS and state regulatory guidelines. Lead, train, and mentor claims staff to meet department performance goals and quality standards. Develop and implement workflow processes to improve claims accuracy and turnaround time. Collaborate cross-functionally with provider relations, finance, utilization management, and IT to resolve claims issues efficiently. Conduct audits and root cause analyses to identify and correct claim errors or trends. Monitor performance metrics and prepare regular reports for leadership review. Serve as a subject matter expert (SME) on ISNP and Medicare Advantage claims processing requirements. Participate in system enhancements, testing, and configuration, especially related to Plexis and other claims platforms. Support compliance activities and maintain thorough documentation of processes and corrective actions. Demonstrated ability to manage teams and drive operational efficiency. Excellent analytical, communication, and problem-solving skills. Strong attention to detail and ability to work independently in a fast-paced setting. Experience working in both plan and provider-based environments. Knowledge of CMS regulations, encounter data submissions, and claims audits. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint). Bachelor’s degree in Business, Healthcare Administration, or a related field (or equivalent experience). 5+ years of claims management experience within a managed care or health plan environment. Strong knowledge of Medicare Advantage and ISNP regulations and operational processes. Experience with Plexis or other claims processing platforms preferred.
Claims Manager
Remote - Must work EST hours
- Please no third party candidates at this time
Description :
We are seeking an experienced Claims Manager to oversee end-to-end claims operations, ensuring accuracy, compliance, and efficiency in processing claims within a managed care environment. The ideal candidate will bring extensive experience in ISNP and Medicare Advantage, with a strong understanding of regulatory requirements, claims adjudication, and process improvement. Experience with Plexis systems is highly desirable.
What You Will Do :
You Will Be Successful If :
What You Will Bring :
About Impresiv Health :
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That’s Impresiv!
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Claim Manager • United States
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