We are a leading national third party administrator, a technology-driven company looking for dependable, positive-minded, team-oriented candidates for immediate consideration in our Claims Department. WEB-TPA offers a fun, dynamic workplace. We promote a professional environment where advancement and financial rewards are based on performance, not seniority. We offer competitive pay and excellent benefits, including medical, dental and vision coverage, STD, LTD, EAP, life insurance, 401k with company matching, educational assistance, and a generous Paid Time Off (PTO) policy. We are located in Irving, Texas, close to the north end of DFW airport and have free covered parking. Our dress code is business-casual on Monday through Thursday, with jeans allowed on casual Fridays.
Responsibilities of the Claims Manager will include:
- Implementing procedures for new clients, reviewing Summary Plan Documents, clarifying plan benefits, plan loading, conducting employee enrollment meetings, and training internal claims and customer service personnel.
- Hiring, training, and managing the claims staff, and managing the claims backlog.
- Clarifying “gray” benefit areas, and training customer service in plan changes and benefits.
- Extensive client contact, which includes traveling to corporate client sites, weekly conference calls, and monthly board meetings.
- Direct contact with providers to resolve contract and payment issues. Traveling to provider billing offices, auditing fee schedules, and negotiating resolution timelines.
- Resolving customer service issues by researching plan coverage, claims history, and routinely educating customers and members through a wide variety of calls and written inquiries.
- Working in partnership with plan sponsors, members, and coworkers to meet and exceed customer expectations and requirements of the organization.
Qualifications/Requirements:
- Minimum of 5 years claims administrative industry experience.
- Experience in Healthcare Industry (Health, Dental, and Vision).
- High School Diploma or equivalent.
- Two years supervisory experience.