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The Manager, Claims Processing reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Manager, Claims Processing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

The Manager, Claims Processing is responsible for leading and overseeing the end-to-end claims adjudication and processing function for a TPA organization. This role manages professional and/or supervisory-level associates and ensures timely, accurate, and compliant processing of complex and specialty home health, DME, home infusion and SNF claims submitted via electronic and paper formats. The Manager applies advanced technical and regulatory knowledge of Medicare, Medicaid, and commercial payers to resolve moderately complex claims issues, opt...