KEY ACCOUNTABILITIES:

• Responsible for the general coordination of the day-to-day functions of the department.
• Monitoring of the claims pre-logging process, assignment and distribution of claims for adjudication.
• Processing of claims for Family Guardian employees.
• Regular monitoring and analysis of adjudicator productivity ensuring output within expectations and identifying and addressing excess capacity opportuniti9es and/or any unsatisfactory performance concerns.
• Assists with the monitoring, reporting and resolution of pending inventory of outstanding claims & claims production levels.
• Regular analysis of claims data to identify possible opportunities for product/process improvement.
• Provide leadership and coaching to direct reports, ensuring adherence to Company policies & procedures and strict timelines for the submission of reports, etc.
• Assist with any other functions assigned by management.

KNOWLEDGE & SKILLS:

•  Bachelor’s Degree or equivalent preferred;
• Minimum 7 years’ experience in claims adjudication and/or claims auditing.
• ACS,ARA,UND,PAHM,ALHC,FLHC,FLMI Designation or Equivalent
• Certified Professional Coder (CPC) Designation
• Knowledge of CPT AND ICD-9/10 coding, and claims adjudication rules and edits
• Must be highly computer literate, especially with Microsoft Office suite of products.
• Ability to communicate effectively, both orally and in writing
• Must possess strong organizational and analytical skills with strong propensity for accuracy.
• Ability to investigate and analyse information, and refer findings appropriately.
• Must exhibit a high level of confidentiality.