Claims Manager - CMAS

New

Skills

Microsoft Office Suite Regulatory Compliance

Lead the CMAS team delivering claims audit, appeals, recoveries, and quality oversight. Ensure accuracy, compliance, inventory management, and timely turnaround. Manage claim inventory against SLAs; set priorities for staff. Coach and develop staff; ensure alignment with benefit plans; monitor performance. Develop and refine operational and quality KPIs; focus on day-to-day performance and regulatory compliance. Identify process improvements including automation and AI-enabled enhancements to boost efficiency and turnaround. Bachelor’s degree or equivalent work experience required. 5+ years in healthcare claims administration; self-funded/TPA preferred. Experience leading teams in claims audit, appeals, recoveries, quality, or escalations. Strong understanding of benefit administration, claims adjudication, and regulatory requirements. Experience with automated/integrated claims adjudication systems (e.g., Javelina, Health Rules Payer). Proficiency with Word, Excel, Outlook, and PowerPoint.

Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: 12 Months

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