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Key Responsibilities:

• Lead & Inspire: You’ll oversee the Claims and Payouts Teams, guiding them to success by ensuring timely, accurate processing of claims within annuity service levels and regulatory standards.
• Drive Efficiency: By championing project and process improvements, you will streamline operations, enhancing both customer satisfaction and operational costs.
• Mentor & Develop: You’ll provide mentorship and training to your team, cultivating a collaborative and high-performing environment where your team members can thrive and grow.
• Ensure Excellence: You’ll monitor daily processes and ensure our customers receive the timely and professional service they deserve.

Preferred Qualifications:

• Education & Experience: A bachelor’s degree is preferred, but if you have equivalent work experience that showcases your ability to succeed in this role, we want to hear from you!
• Growth Mindset: We’ll support you in obtaining your FINRA Series 6 license within your first 12 months. If you’re ready to invest in your professional growth, we’ll be right there with you.
• Industry Expertise: If you have at least 5 years of experience in the industry, that’s fantastic. However, we value a passion for the field and a commitment to learning just as much.
• Commitment to Continuous Learning: This role offers opportunities for ongoing education and professional development. We encourage and support you in taking industry courses to keep growing in your career.

How to Apply:

If you’re interested in this opportunity or any others with our company, please view our Career Site.
Application URL : Careers with Constellation

Key Responsibilities:

• • Claims processing and claims examining of all incoming claims based on departmental procedures.
  • Understand the knowledge of hospital and physician billing and collections, knowledge of Medicare A & B, Medicaid, Commercial and PPO claims processing
  • Interpret, apply and comprehend policy terms, deductibles, coinsurance, copays and policy max
  • Coding ICD 9 (ICD 10 helpful), knowledge of how to process claims, how to read and interpret policies, CPT codes, Hospital coding and UB 04, Correct Coding Initiative principles and
  • Meets deadlines promised to clients for claims processing.
  • 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 Payerfusion criteria.
  • Medicare Advantage plans, capitation plans, risk assessment process and payments
  • Follow up on network pending claims to ensure that they are released meeting the deadlines. Provide the client with updates when the claims are pending until the claim is released.
  • Receive and register appeals/balance billing cases into the system (claim notes, image the documents in the patient’s file), spreadsheet and distribute according to department procedure.
  • Review and determine, according to department procedure, how to resolve the appeal/balance billing.
  • Provide continues update to both client and provider until appeal/balance billing case is closed.
  • Handles Provider Statements/invoices by contacting the providers to request a complete claim form
  • Performs other similar and related duties as needed.

Preferred Qualifications:

• • Must have experience in claims processing and adjudication in the Commercial Health Insurance, PPO and Medicaid Industry.
  • Must have extensive knowledge of hospital and physician billing and collections, knowledge of Commercial and PPO claims processing a must. Medicare, Medicaid experience optional and a plus.
  • Must be able to interpret, apply and comprehend policy terms, deductibles and coinsurance.
  • Self-motivated, responsible, and with a desire for advancement.
  • Must have excellent English written and verbal communication skills.
  • Must be proficient with the use of telephone in dealing with customers, providers and members.
  • Must be fully computer literate in use of Microsoft Office Programs (Word, Excel, Outlook, Teams and other everyday office support software

How to Apply:

For inquiries or if you’re interested in this opportunity, please reach out to Debra Dickstein, HR Manager, by email to submit your resume at corphumanresources@payerfusion.com.
Application URL : Careers – PayerFusion

Key Responsibilities:

• Performs supervisory duties including, but not limited to, hiring, training, evaluating, and disciplining direct reports. Fosters a positive and engaged work environment. Coaches associates and assists in associate development.
• Assesses projects, develops plans, and assigns and assesses work of staff.
• Works with all departments in the Operations division and other departments within RGA Re to identify and resolve problems/issues. Develops relationships with client companies and seeks resolutions to ensure customer satisfaction.
• Recommends and participates in the development and implementation of process improvements within an area of oversight, and with approval of department leadership. Collaborates with other members of the US Ops Management team to implement and manage to goals/plans/budgets that align with division and company objectives.

Preferred Qualifications:

• Bachelor’s Degree or equivalent related experience in insurance or reinsurance
  5-8 years insurance related experience
• 1-2 years experience in a senior technical/professional, project lead, or supervisory position
• Reinsurance industry knowledge
• Progress toward FLMI, ALHC or other relevant professional accreditation

Key Responsibilities:

• Expertise Development: Maintain an advanced working knowledge of claims procedures, policies, system applications, and company life and annuity product features.
• Team Leadership: Drive the execution of team objectives, service delivery, and expectations by planning, organizing, and directing team members.
• Strategic Planning: Participate in strategic planning to develop operational plans that maximize departmental efficiency, productivity, and performance.
• Talent Development: Develop an internal talent pipeline by setting team and individual goals, coaching for performance, and fostering individual growth and development.
• Cross-functional Collaboration: Partner with stakeholders across the organization to drive large-scale initiatives and champion successful change implementation to create value.
• Support and Coordination: Provide ad hoc support for escalations and highly complex claims, and coordinate with leadership, sales, legal, compliance, reinsurance, underwriting, and actuarial teams to ensure contractual and company practices are maintained.
• Mentorship and Training: Mentor and support the technical training of examiners and participate in cross-organizational claim education.
• Professional Growth: Commit to ongoing professional development, including participating in industry conferences and maintaining industry relationships.

Preferred Qualifications:

• 6+ years of industry experience as a Claims Examiner or Underwriter, preferably in Life, Annuity, Disability, Long Term Care or Health insurance
• 3+ years of management experience, with a demonstrated ability to direct others, including developing, training, and executing performance goals.
• A comprehensive understanding of claims appeals, denials, medical terminology, and contract language.
• Exceptional leadership, team management, and interpersonal communication skills.
• Bachelor’s degree preferred, but applicants of various backgrounds are encouraged to apply
• Preferred background includes insurance industry and business process designations such as ALMI, FLMI, ALHC, FLHC, and CLU
• Proficiency with life insurance industry core systems, including claims, enterprise content management, and customer relationship management, as well as collaboration platforms

Job Description:

The Head of Claim Services will oversee a wide range of claims operations across life, preneed, and health product lines, including initiation, analysis, and auditing. This senior leader will lead fraud prevention and streamlining processes while enforcing clear claims guidelines, predicting claim volumes, and ensuring top-notch quality standards. They will work closely with Actuarial staff, manage the claims review committee activities, and handle audits. Lastly, they will guide vendor selections and address policy owner complaints effectively.

Required Qualifications:

• 8+ progressive years of experience in supervisory/managerial positions in claims service and management
• Broad view and understanding of claims administration beyond single-provider (claims administration technology, TPAs, etc.)
• Strong analytical skills and experience with generating reports and dashboards using claims data
• Knowledge of Electronic Data Interchange (EDI) for claims processing and system performance monitoring
• Experience leading large organizations and managing significant claims budgets
• Bachelor’s of Business Administration or equivalent experience

Preferred Qualifications:

• Experience in selecting and managing vendors for clearinghouses, payments, cost containment, networks, and claim processing
• Claims experience across multiple product lines including life insurance, preneed, Medicare Supplemental, dental insurance, and pet insurance (experience in all product lines is not required)
• Experience with special investigations and fraud prevention programs in the insurance industry
• The ability to participate in risk management meetings and analyze claim trends
• Understanding of relevant insurance regulations and compliance requirements