- Assist with the supervision of staff specific but not limited to training, planning, and directing work.
- Responds to staff, internal and external customer inquiries, and provides resolution to issues accordingly.
- First point of contact for customer calls that require research and a response.
- Manages assigned tasks, queues, and ensures inventory is handled within department guidelines.
- Manages internal emails, tracks inventory, and collaboration with staff for timely responses within department guidelines.
- Collaborate with reporting manager to ensure turn-around times, quality standards and company goals are met.
- Trend errors for assignments, identify training needs for staff, collaborate with quality assurance on unit module updates.
- Attends staff meetings to assist with delivery of materials, trainings, and communication.
- Assists in the coordination of the work flow and control of work procedures.
- Provides guidance to subordinates regarding general claims and escalated issues.
- Communicates directly with clients, providers, and internal and external areas.
- Adherence to company and department policies and procedures.
- Understands the guidelines for timeliness and the expected turnaround time within the department.
- Must occasionally travel to client locations.
- Performs other duties as assigned.
Two to four years of management and claims experience. Must be computer literate w/proficiency in spreadsheet and word processing applications. Excellent written and verbal communication skills. Must have excellent leadership abilities and interpersonal skills; ability to establish confidence, rapport and foster cooperative relationships with clients, providers, and co-workers. Must understand self-funded payer claims policies as well as Federal, State and other regulations pertaining to health insurance claims payment including TPL, COB, and coding and reimbursement methodologies. Experience with automated claims systems; and ability to maintain sound production operations also required.
Supervision: This position reports directly to a Stockton Claims Manager, limited supervision with considerable responsibility for work quality and quantity
Skills Required
- Two to four years of management and claims experience
- Computer literacy with proficiency in spreadsheet and word processing applications
- Excellent written and verbal communication skills
- Excellent leadership and interpersonal skills
- Ability to establish confidence, rapport, and cooperative relationships with clients, providers, and coworkers
- Understanding of self-funded payer claims policies
- Understanding of federal, state, and other regulations related to health insurance claims payment, including TPL and COB
- Knowledge of coding and reimbursement methodologies
- Experience with automated claims systems
- Ability to maintain sound production operations
What We Do
WM Michael Stemler, Incorporated, doing business as Delta Health Systems (DHS), is a leading Third Party Administrator (TPA) for self-funded health plans. The company provides insurance services, specializing in medical insurance claim processing and the administration of flexible spending accounts (FSA), offering resources and an online FSA store to help members and providers manage healthcare spending effectively.
