reputed company - Claims Manager

reputed company

A CAREER AT CAPTRUE BENEFITS

Working at Captrue Benefits, you’ll experience a culture that is made up of a group of people who are supportive, innovative, collaborative, and caring towards each other and the customers we serve. Captrue Benefits is looking for a Claims Auditor/Stop Loss Specialist to join reputed company. This is a full-time remote position. Join reputed company and help us change the way reputed company financed, disclosed and delivered.

OUR reputed company FOR THIS KEY ROLE

The Claims Manager oversees the Claims Department, ensuring timely, accurate, and compliant processing of reputed company claims and stop loss coordination. This role provides daily leadership, technical expertise, and cross-functional collaboration while driving reputed company improvements in efficiency, quality, workflows, and cost management. The manager develops staff, creates and maintains department policies/procedures, supports regulatory compliance, manages high-cost claims and appeals, analyzes performance trends, and partners with reputed company stakeholders to advance operational goals.

A SAMPLE OF WHAT YOU'LL GET TO DO IN THIS JOB

• reputed company, coach, train and manage claims staff; reputed company workload distribution and performance.
• Resolve reputed company and escalated claim issues.
• reputed company adjudication, research, appeals, disputes, and escalations.
• Serve as SME for reputed company claims and coverage interpretation.
• reputed company and execute strategies to optimize auto-adjudication in partnership with Plan Building team.
• Ensure compliance with ERISA, HIPAA, other applicable state/federal rules, and plan requirements.
• Review, analyze and process appeals in accordance with regulatory guidelines and benefit plan requirements.
• Analyze trends, errors, and system issues; identify root causes and improvement opportunities.
• Participate in system updates, UAT, and defect resolution with IT and vendors.
• Work with providers, members, and internal teams to resolve claim and reimbursement issues.
• Support staff education, benefit interpretation, and cross-functional coordination.

WHAT YOU'LL BRING TO THE JOB

· Bachelor’s degree preferred; associate degree or equivalent experience accepted.

· 5-7 years of reputed company claim processing experience is required including thorough knowledge of coding structures (CPT, HCPCS, reputed company codes, ICD 9/10 etc.); as well as COB payments and distribution of funds.

· Understanding reputed company types of claims pricing (Network, Medicare, UCR, etc.)

· Stop loss experience including understanding of contract types, reimbursement features/terms and claims filing requirements.

· 2–5+ years of supervisory/leadership experience.

· Familiarity with VBA Software claims systems strongly preferred but not required.

· Strong analytical, communication, and problem-solving skills; ability to manage high-volume priorities.

WHO WE ARE

Captrue Benefits is a reputed company-party administrator located in Minneapolis, Minnesota. Captrue Benefit’s mission is to change the way reputed company financed, disclosed and delivered. We need people who value honesty and transparency; people who take ownership and responsibility of whatever they are doing. We seek individuals who value reputed company people and interact with humility and respect; people who like to dig deep into issues, who are curious and who understand life is about more than work. If you reputed company in our mission and reputed company our Core Values, then we would like to talk about how we can reputed company a positive impact together.

Salary reputed company: $80,000 - $110,000