Group 1001
is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.
Company Overview:
Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued.
Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals. All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.
Job Summary
The Claims Manager will be responsible for managing the claims, subrogation and COB team while ensuring timely and accurate processing of medical claims.in accordance with all applicable CMS guidelines. KPI will be collected and reported to the Sr team on a monthly basis.
Main Accountabilities
Ensures claims processes are followed in accordance with established guidelines and requirements.
Addresses and resolves escalated issues timely.
Facilitates meetings and provides training, performance feedback and coaching to claims staff.
Completes and conducts performance reviews, monitors individual staff performance and works in conjunction with the human resources department to resolve performance issues/problems.
Assumes responsibility for completion of assigned duties. Exercises authority required to accomplish assigned duties and responsibilities and accepts full accountability for results achieved.
Plans and schedules work so that it can be performed efficiently and effectively, reduces costs where possible by improving methods and processes and eliminating non-essential and manual processes and activities.
Learns new skills and expands job knowledge to better perform assigned duties.
Other duties as assigned to assist in the overall productivity and well-being of the company in general.
Qualifications
Minimum 5- 7 years’ experience in healthcare claims operations
2 years in team lead or supervisory role in healthcare.
Thorough understanding of CMS regulations, standard operating procedures, coordination of benefits and subrogation processes.
Analytical, process improvement, data driven decision making, critical thinking and human relations skills are critical.
Effective communication skills; ability to obtain information from others and deliver information to others orally and in written form.
Ability to work with little supervision and direction.
Benefits Highlights:
Employees who meet benefit eligibility guidelines and work 30 hours or more weekly, have the ability to enroll in Group 1001’s benefits package. Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options. Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability, and to enroll in the Company’s Employee Assistance Program and other wellness initiatives. Employees may also participate in the Company’s 401K plan, with matching contributions by the Company. #LI-AT1
