Manager of Claims

The Manager of Claims / System Admin for the PACE program is responsible for overseeing all functions of the claims department, overseeing the claims team, and serving as the subject matter expert and system administrator for the claims adjudication system. This role ensures timely and accurate processing of claims, implements system enhancements, and builds the operational efficiency needed to support program growth.  This position is full time M-F 8am to 4pm.

Essential Responsibilities :

• Recruits, develops, mentors and motivates staff.  Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
• Manages day-to-day operations of the claims department, ensuring accuracy, timeliness and compliance with regulatory and contractual requirements.
• Serves as the subject matter expert for all PACE claims-related processes and policies.
• Acts as the system administrator for the claims adjudication platform, maintaining configuration, user access and system performance.
• Designs and implements rules, logic and automation within the claims system to improve efficiency and reduce manual processing.
• Collaborates with IT, Finance, Compliance and other departments to identify and resolve claims issues and enhance workflows.
• Develops and monitors metrics to track claims performance, including auto adjudication rate, turnaround time and accuracy.
• Leads or supports testing and implementation of system upgrades, enhancements and integrations.
• Develops and maintains standard operating procedures, training materials and audit processes.
• Provides coaching and leadership to the claims team to ensure continuous improvement and professional growth.
• Performs other duties as assigned.

Job Specification :

Salary range :   130k to 140k annually

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Compensation details : 130000-140000 Yearly Salary

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