Director of Claims

Bronx, NY

Post Date: 03/13/2018 Job ID: 4637 Department: Financial Services

Title: Director of Claims

Location: Bronx, NY 10460

Industry: Healthcare

Occupational Category: Finance

Hours: Full-time

Description: Hiring a Director of Claims for a managed long-term care program (MLTCP). The Director of Claims is responsible for the overall functioning of claims processing, including claims adjudication, provider relations, data analysis and reporting, and process improvement. The Director of Claims will provide oversight and supervision of the Claims Specialists.


  • Gather and analyze provider claims data
  • Identify and implement workflow processes improvements
  • Oversee and manage the Claims Specialists, including hiring, training, terminating, disciplining, and completing performance evaluations
  • Enter provider information into MCO software
  • Setup fee schedule for providers in MCO
  • Monitor Pending Claims Report
  • Investigate and resolve denied claims with providers
  • Answer calls from Providers when needed
  • Analyze, reprocess and adjudicate claims to ensure processing accuracy
  • Process the check run file from Relay and submit to the bank

Experience Requirements:

  • 10 - 15 years of progressively responsible healthcare claims experience

Desired Skills:

  • Knowledge of and experience working with Medicare Advantage programs
  • Knowledge of Medicare regulations and policies
  • Ability to analyze and interpret general business correspondence and procedure manuals
  • Present information effectively and respond to questions from providers
  • Present information effectively to providers and Claims Director
  • Advanced computer skills (MCO, Excel)
  • Ability to calculate multiple complex payment rules
Apply Online

Not ready to apply?

Send an email reminder to:

Share This Job:

Related Jobs: