Related skills
microsoft excel microsoft outlook microsoft powerpoint microsoft word javelina📋 Description
- 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.
🎯 Requirements
- 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.
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