Claims Manager
DELTA HEALTH SYSTEMS MCC · Fresno Claims Office - Fresno, CA 93720
Delta Health Systems (DHS), one of the nation’s leading Third Party Administrators (TPAs) for self-funded health plans, is seeking an experienced and collaborative leader to join our team as Claims Manager. This position oversees day-to-day operational functions for our Stockton and Fresno offices and plays a key role in driving operational excellence, team development, and customer satisfaction.
Essential Duties and Responsibilities
- Supervise assigned staff in a responsible manner including training, planning, directing work, appraising performance, rewarding, and addresses complaints.
- Mentors, educates, and provides corrective action, performance improvement plans, and disciplines staff when necessary.
- Participants in the interview process for the hiring of new staff when necessary.
- Conducts monthly 1:1, quarterly, and annual performance reviews with staff to discuss productivity, issues, concerns, quality, and expectations.
- Responds to staff, internal and external customer inquiries, and provides resolution to issues accordingly.
- Evaluates department performance and takes corrective action, when necessary,
- Ensures overall inventory and assigned queues and processes are handled within department guidelines.
- Reviews department reports for accuracy, thoroughness, and timeliness and adjusts measurements when necessary.
- Interprets plan provisions and make recommendations for system administrative improvements to meet customer expectations.
- Develop relationships with other departments to ensure interdepartmental communication is effective.
- Develops and maintains effective relationships with customers and their affiliated partners.
- Manages within established budget of unit.
- Collaborates with information services on system enhancements, providing documentation and justification for improvements to system for proper claims flow.
- Assists Client Services with client requests to meet customer expectations, requests, and deadlines.
- Participate in new business implementations.
- Enforces, adheres to, and follows department policies and procedures and Collective Bargaining Agreements.
- Participates in and contributes to department meetings and continual training.
- Represents company at existing and prospective customer meetings.
- Upholds and exemplifies company values.
- Must occasionally travel to client locations.
- Performs other duties as assigned.