Director of Claims

Company: Kforce Finance and Accounting ( Learn More )

General Information

Location:	US-FL-Fort Lauderdale
Base Pay:	N/A
Req'd Education:	Not Specified
Employee Type:	Full-Time
Req'd Experience:	Not Specified
Req'd Travel:	Not Specified
Manages Others:	False
Relocation Covered:	False

Job Description Responsibilities: Our client is seeking a Director of Claims in Ft. Lauderdale, Florida (FL).The Claims Director establishes, implements, and performs claim auditing functions and oversight. The Director shall set objectives and priorities and coordinate work activities, functions, and projects to meet goals and objectives.

Provides reports, analysis, and corrective action plans

Create, implement department standard for both quality and quantity of claims and phone coverage

Establish, develop and implement standard health care organization claims functions such as: Auditing, production cycles, accuracy, timeliness, quality checks for accuracy rates systems, production goals, and other standard operations for claims

Provide for: COB, Subrogation and Re-Insurance strategies to maximize recoveries

Develops and implements management reports to track the accuracy and timeliness of claims processing

Evaluates claims processing systems, manual and automatic, to identify areas for development; implements changes as necessary

Ensures compliance of plan or claims entity with current and any updated AHCA, DFS, or CMS guidelines

Provides for financial reports, claims paid, and other adjudication processes

Develops department staffing and budget needs

Planning and forecasting for short and long-range objectives

Develops meetings to report activities and develop actions

Conducts system and process trainings

Job RequirementsQualifications:

Bachelor's degree or equivalent experience
5+ years as claims manager for insurance/health care company
7+ years in claims department
Broad claims and authorization experience at multiple levels, of the industry, from front entry level through managerial in claims, provider relations, cost containment, and quality control coordination of benefits/subrogation, customer service
In-depth knowledge of claims processing procedures, guidelines and support functions
Working knowledge of medical/dental terminology, diagnosis and procedure codes and their reference manuals

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