Manager Claims Operations

Manages associates in completing department functions and ensures that the area of responsibility runs in a cost effective and quality manner providing prompt, accurate, and professional responses. Ensures timely and accurate processing of claims processing for all products (PA & NJ) for Local and BlueCard business, including Government products Medicare Advantage & MediGap. • Represents IBX in group and government audits and legal matters in a business capacity • Maintains oversight vendor activities • Handle compliance, regulatory and delegation tasks, including meetings. • Achieve and maintain performance standards for the department in accordance with BCBSA and PA & NJ requirements • Evaluate the effectiveness and efficiency of operational areas and take action to reallocate resources as necessary. • Manage work processes, measure non-conformance and identify corporate and department policies and procedures to achieve operational efficiencies. • Interpret, communicate, and implement corporate and department policies and procedures. • Maintain positive working relationships with internal and external customers to resolve departmental issues. • Approve special consideration and handling for customers as appropriate. • Compile and prepare required data pertaining to unit performance, budget, training, surveys, projects, audits, attendance, etc. • Identifies the support and implementation of process improvements that impact overall service and reduces overall costs. A. A high school diploma or equivalent is required. B. 5 years' experience in a health care or related setting, with two years in a leadership capacity • Comprehensive knowledge of claims operations, including processes, regulations, and best practices. • Excellent interpersonal and leadership skills to effectively interact with direct reports, internal teams, and external customers. • Strong organizational skills and attention to detail in a fast-paced environment that change frequently. • Problem-solving ability to identify issues, develop resolutions, and educate customers on solutions. • Exceptional communication skills with the ability to engage and convey information clearly across all levels of the organization.