Florida Blue · 13 hours ago
Assistant Manager of Claims Processing
Irving, TX, United States
Full-time
Onsite
Mid, Senior Level
3+ years expFlorida Blue is a healthcare third-party benefit administrator with over 30+ years of experience building unique benefit solutions. The Assistant Manager of Claims Processing is responsible for managing a team of Claims Examiners for the day-to-day operations of claims.
ConsultingHealth CareInsurance
Responsibilities
Serve as SME and primary point of contact with all claims processing related questions
Accountable for hiring new employees which includes partnering with Talent Acquisition team, conducting interviews, feedback and approvals. Manages an Onboarding plan for new hires, coordinates with Talent Development Dept training plans, check-ins and progress reports
Manage and review claims, open notes, and check backlog on a daily basis. Assess and assign claims processing prioritization, make adjustments when necessary to ensure deadlines and performance guarantees are being met
Review established metrics for quality and accuracy of claims processed. Partner with Internal Audit and Auditors in assessing metrics and areas of concern or improvement
Coach employees on performance. Checks in with employees on a regular basis via 1:1 meetings. Makes recommendations to Claims Examiners and to Sr. Management for areas of opportunity. Conducts performance appraisals
Reward and recognize team members for successfully performing goals and objectives and fosters a team environment upholding company mission, vision, values
Partners with HR on issuing any disciplinary issues and terminations complying with established processes and procedures to ensure compliance and fairness
Serve as Timekeeper reviewing timecards. Submit requests for OT to Sr. Manager & Leadership for approval. Reviews and approves or denies PTO requests based on the needs of business
Process claims at the highest dollar threshold and review more complex items
Investigate claims in question by members or clients
Assist Manager with call backs for members and providers
Communicate directly with both clients and internal teams to resolve any issues or concerns
Complete claim testing for benefit changes, renewals, and new groups
Review claim benefits issues with IT/Plan Build
Update and create benefit grids as necessary
Assist SilverSkills with any claim questions or audits
Qualification
Required
2+ years related work experience as a claims examiner or adjudication experience on a computerized claims payment system in the healthcare industry
1+ years direct supervisory/management experience
Related Bachelor's degree or additional related equivalent work experience
Must possess proven judgment, decision-making skills and the ability to think analytically
Must learn quickly as well as be able to multi-task
Concise written and oral communication skills required, including the ability to deal with conflict
Experience in processing all types of medical claims
Must be motivated as well as possess a sound work ethic
Ability to maintain good rapport with clients, providers and internal employees
Excellent written and verbal communication
Knowledge of all MS Office products
Proficiency and experience with WebTPA systems
Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees
Benefits
Medical, dental, vision, life and global travel health insurance
Life insurance, Short- and long-term disability programs
Leave programs to support personal circumstances.
401(k) includes employer contribution match
Paid time off, volunteer time off, and 11 holidays
Additional voluntary benefits options avaliable
Comprehensive wellness program
Company
Florida Blue
Florida Blue is a subsidiary of a not-for-profit health solutions company dedicated to serving all Floridians in the pursuit of health.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Patrick Geraghty
President and CEO
Recent News
2025-11-04
Company data provided by crunchbase