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Directs and oversees the operations of an insurance claims department to meet operational, financial, and service requirements. Establishes policies and procedures for the administration of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Responsible for the strategic processing and payment of claims. Maintains up-to-date- knowledge of legislation, regulations, and industry events which pertain to insurance claims. Provides expert guidance and consultation to staff on the most complex claims. Requires a bachelor's degree. Typically more...
Directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Provides professional knowledge and guidance on technical or procedural problems. Creates claims audit policies and procedures. May recommend changes in claims processing procedures. Typically Requires a bachelor's degree. Typically reports to top management. Manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the f more...
Plans and directs one or more departments responsible for administration of health insurance claims, payment processing, billing research, and responding to inquiries. Establishes and implements organizational policies and procedures; may offer guidance on the appropriate handling of complex or high-value claims. Develops and executes strategic business plans for the department. Coordinates operations with other areas of the organization. Requires a bachelor's degree. Typically reports to top management. Manages a departmental sub-function within a broader departmental function. Creates functi more...
The Medical Claims Operations Director establishes and implements organizational policies and procedures; may offer guidance on the appropriate handling of complex or high-value claims. Plans and directs one or more departments responsible for administration of health insurance claims, payment processing, billing research, and responding to inquiries. Being a Medical Claims Operations Director coordinates operations with other areas of the organization. Develops and executes strategic business plans for the department. In addition, Medical Claims Operations Director requires a bachelor's degre more...
The Claims Service and Operations Director provides guidance and sets policies on insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Directs and oversees the operations of an insurance claims department to meet operation, financial, and service requirements. Being a Claims Service and Operations Director keeps abreast of any changes to legislation and regulations which pertain to insurance claims. Responsible for the strategic processing and payment of claims. In addition, Claims Service and Operations Director provides guidance to su more...
Manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the v more...
Manages the claims quality auditors and daily activities of quality claims audit function. Reviews and tracks claims quality audit reports and measures performance of auditors. Provides assistance in developing claims audit policies and procedures. May provide coaching in complex claims audit. Typically requires a bachelor's degree. Typically reports to a director or head of a department. Manages subordinate staff in the day-to-day performance of their jobs.True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority fo more...
The Claims Quality and Compliance Audit Director provides professional knowledge and guidance on technical or procedural problems. Directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Being a Claims Quality and Compliance Audit Director may recommend changes in claims processing procedures. Creates claims audit policies and procedures. In addition, Claims Quality and Compliance Audit Director typically requires a bachelor's degree. Typically reports to top management. The Claims Quality and Compliance Audit Director more...
The Home Care Claims/Reimbursement Director sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Directs and supervises the activities of the benefits claims and provider reimbursement personnel in a home care environment. Being a Home Care Claims/Reimbursement Director produces the documentation necessary for reimbursement, Medicare Compliance, and control of receivables. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims. In addition, Home Care Claims/Reimbursement Director may require an advanced degree. Typicall more...
The Provider and Claims Reimbursement Services Director handles third-party reimbursement for services rendered to patients. Directs and supervises the activities of the claims and provider reimbursement personnel. Being a Provider and Claims Reimbursement Services Director monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. In addition, Provider and Claims Reimbursement Services Director develops policies and procedures compliant with fiscal and regulatory requir more...
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