Manager, Part C & Authorizations

📋 Description

• Oversees day-to-day adjudication operations for authorizations, claims, and encounters.
• Ensures regulatory compliance and high-quality output by internal teams and vendors.
• Collaborates across functions to resolve data discrepancies and maintain production stability.
• Develops and maintains reports to show service authorization efficacy.
• Engages Enrollment & Eligibility and Provider Network on contract timing and pricing issues.
• Conducts retrospective reviews and monitors encounter data submissions for accuracy.

🎯 Requirements

• 7+ years in health insurance operations with leadership experience
• Bachelor's degree in healthcare, finance, or related field (Master's preferred)
• Proven expertise in claims processing and utilization management
• Strong customer service orientation and handling of confidential data
• Excellent verbal and written communication skills
• Proficient in Microsoft Word, Excel, PowerPoint

🎁 Benefits

• Health and life insurance
• Equity program participation
• Paid time off including vacation and sick leave