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Posted: Sunday, March 4, 2018 1:48 PM

Job Description
Medical Claims Manager for PAI will support and manage a team that supports customers on the West Coast. The ideal candidate will have demonstrated success in managing a team of medical claims processors. They wil need to be able to work in a fast paced environment, have strong interpersonal and communication skills, attention to details, outstanding ability to multi:task and prioritize, and strong analytical skills. Perform management and administrative tasks related to client needs and interact with clients to provide information in response to inquiries about products and services, handle and resolve complaints.
Primary Responsibilities: (subject to change and special projects may be assigned)
Manage day:today activities, guide, lead and manage.
Attend client meetings and conference calls.
Process or adjust medical insurance claims in accordance with policies and procedures.
Ability to read EOBs and healthcare terminology.
Identify research and resolve claim issues. Request for additional documentation.
Promote teamwork and service delivery success.
Insure contractual performance guarantees related to payment processing timeliness and accuracy are met.
Insure contractual performance guarantees related to various means of client communications are met (phone, email, mail etc.).
Assist in the client appeals process.
Create and update financial batch records for processing by accounting.
Manage workflow for the team to ensure service levels are achieved.
Manage call logs
Recommend process improvements.
Associates Degree preferred and or equivalent related experience.
Must Have have a Medical Coding Certificate
Must have experience as a Medical Coder
Assist in proprietary system rollouts
Speaking : Talking to others to convey information effectively.
Knowledge of Medical Insurance Practices : Enrollment; Payment Terms related to insurance premiums and out of pocket expenses; Benefits Coordination with other insurance coverage, ensuring payer of last resort.
Analytic Skills : Ability to review and understand payment/account history.
Active Listening
Service Orientation : Actively looking for ways to help people.
Writing : Communicating effectively in writing as appropriate for the needs of the audience.
Reading Comprehension : Understanding written sentences and paragraphs in work related documents.
Proficiency with all MS Office applications (Excel, Word, Outlook, etc.)
The above is intended to provide general guidance regarding the responsibilities of the position. It is not intended to be an all:encompassing definition of what the position entails and may be changed at the discretion of Senior Management at any time.
PAI is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law.
Company Description
We are passionate about improving access to healthcare and human services by working together to solve fundamental issues for people in need.
By combining our unique expertise, our team approach and technology systems, PAI successfully administers various subsidy programs such as senior prescription drug subsidies, Ryan White subsidies, reinsurance and risk pool programs.


• Location: Glastonbury, Hartford

• Post ID: 23486592 connecticut is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2018