Top 202 Claims manager Jobs in Baltimore, Md

RN Manager Grievances & Appeals
MedStar Health —Columbia, MD
- $102,606 - $196,996 a year
- Full-time
- Hybrid work
- Microsoft Word
- Background check
- Nursing
Quick Apply
8d
Payment Policy Manager (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $114,080 - $211,761 a year
- Full-time
- Microsoft Excel
- Management
- Research
- 401(k)
Quick Apply
NCQA Quality Manager (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $108,000 - $200,475 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Customer service
- 401(k)
Quick Apply
Manager, Leave Administration & Workers' Compensation
Breakthru Beverage Group —Linthicum, MD
- $96,600 - $120,000 a year
- Full-time
- Hybrid work
- 5 years
- Office
- Analysis skills
- Health insurance
- 401(k)
Quick Apply
11d
Claims Supervisor
Chesapeake Employers Insurance Company —Towson, MD
- $86,164 - $133,556 a year
- Full-time
- Hybrid work
- Bilingual
- 7 years
- Writing skills
- Disability insurance
- Health insurance
Quick Apply
2d
Project Manager - Insurance Restoration (AAction Home Repairs)
Strongpoint Talent —Millersville, MD
- $70,000 - $90,000 a year
- Full-time
- Mid-level
- Residential
- Driver's License
- Fuel card
- Paid holidays
Quick Apply
Property Manager (Multi-Building/Mixed Use Asset) – Hampton Plaza
The Bernstein Companies —Towson, MD
- Office
- Residential
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
7d
Assistant Dental Office Manager
KB Staffing Solutions Group —Baltimore, MD
- From $29 an hour
- Full-time
- Dental office
- Mid-level
- 3 years
- Paid holidays
- Dental insurance
Quick Apply
8d
Regional Safety Manager
The Berlin Steel Construction Company —Glen Burnie, MD
- Full-time
- Clean driving record
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Disability insurance
Quick Apply
Case Manager/Paralegal
Saiontz & Kirk. P.A. —Baltimore, MD
- $40,000 - $60,000 a year
- Full-time
- Background check
- Research
- Mid-level
Quick Apply
Healthcare Project Manager - (FACETS Claims Systems)
System One —Baltimore, MD
- $55 - $64 an hour
- Hybrid work
- Bachelor of Science
- Team management
- Senior level
- Health insurance
- Dental insurance
Quick Apply
8d
(i) Program Manager – Core Consolidation / FACETS Transformation
System One —Baltimore, MD
- $75 - $91 an hour
- Bachelor of Science
- Agile
- 1 year
- Health insurance
- Dental insurance
Quick Apply
4d
(ii) Technical Program Manager / Technical Delivery Manager – FACETS
System One —Baltimore, MD
- $78 - $84 an hour
- Management
- Bachelor of Science
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
4d
Property Casualty Claims Manager
Faculty Physicians Inc. —Baltimore, MD
- $83,400 - $125,000 a year
- Mid-level
- 3 years
- Bachelor's degree
Quick Apply
Pharmacy Program Manager (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $106,632 - $211,783 a year
- Full-time
- Master's degree
- Analysis skills
- Bachelor's degree
- 401(k)
Quick Apply
Program Manager - Pharmacy Supply Chain - (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $106,632 - $211,783 a year
- Full-time
- Remote
- Master's degree
- Analysis skills
- Bachelor's degree
- 401(k)
Quick Apply
Telephonic Case Manager I
CorVel Corporation —Nottingham, MD
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Manager, Technical Training
Peraton —Windsor Mill, MD
- $104,000 - $166,000 a year
- Master's degree
- Senior level
- Business
- Health savings account
- Paid holidays
Multisite Business Office Manager
Summit Ambulatory Surgical Center - Woodhomle (10505) —Pikesville, MD
- $30.41 - $44.09 an hour
- Full-time
- Bachelor's degree
- Experience equivalent to degree accepted
- Business Administration
- Health savings account
- AD&D insurance
Account Manager-Claims Reporting
Lumelight —Pikesville, MD
- $50,000 - $65,000 a year
- Extended hours
- Microsoft Outlook
- HIPAA
- Mid-level
- Disability insurance
- Health insurance

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claims manager jobs near baltimore, md

RN Manager Grievances & Appeals

MedStar Health -
Columbia, MD

Quick Apply

Job Details

Full-time
$102,606 - $196,996 a year
8 days ago

Qualifications

Nursing
RN License
Supervising experience
Bachelor's degree
Case management
Utilization management
Resource utilization in healthcare
Bachelor's degree in nursing
Certified Case Manager
General management
Hospital experience
Nursing

Full Job Description

About this Job: General Summary of Position
Responsible for day to day oversight and management of Intake Clinical Appeals Claims Appeals Complaints Grievances and Intake functions. The Manager of Appeals Complaints and Grievances will be dedicated to delivering service and operational excellence through a focus on continuous improvement in the areas of contribution competencies and performance of the Intake Appeals Complaints and Grievances team. This role will be tasked with overseeing intake the development and operational execution of all appeals (clinical and non-clinical) complaints and grievance processes in line with regulatory standards while enhancing quality and effectiveness. Additionally the role will need to utilize advanced technical knowledge to resolve complex issues. This involves setting objectives creating policies and procedures determining approaches allocating resources and managing inventory.

Primary Duties and Responsibilities

Oversees and provides direction for Intake Appeals (Clinical and Claims) Retrospective Review Emergency Room Review and Customer Service/Complaints/Grievances for all lines of business.
Oversees and analyzes critical data and reporting as required by MedStar Family Choice for areas of responsibility. Ensures appropriate data collection and timely submission.
Develops and contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations.
Actively participates with annual strategic planning objectives for MedStar Family Choice. Initiates innovative ideas and programs to improve quality while maintaining or reducing medical expense.
Provides oversight to ensure that retrospective events appeals and complaints/grievances timeframes are in compliance with NCQA EQRO State of Maryland District of Columbia Federal and any other applicable standards.
Maintains working knowledge of MFC authorization rules for MD and DC and facilitates appropriate training to ensure that MFC associates practitioners facilities and vendors are aware of authorization rules.
Acts as the clinical liaison with IT and subject matter expert for Appeals Grievances and Customer Service with respect to the clinical software system. Maintains close affiliation with the support service team to ensure the system operations meet departmental functions troubleshoots issuers coordinates testing for system upgrades and coordinates appropriate training for associates. Acts as a resource to staff using the software.
Oversees the selection orientation training program and assignment of new and current associates. Maintains up to date training manuals for assigned departments.
Develops standards of performance evaluates performance and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs provide feedback discuss new developments and exchanges information.
Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
Performs other duties as assigned.

Minimal Qualifications
Education

Bachelor's degree in Nursing required

Experience

3-4 years Utilization management experience required and
5-7 years Diverse clinical experience in a hospital or medical setting required and
1-2 years 2 years supervisory experience required
Additional experience with appeals and grievances preferred

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the State of Maryland upon hire and valid RN licensure in the District of Columbia (DC) prior to start date in position. Upon Hire required and
CCM - Certified Case Manager Active Certified Case Manager (CCM) or CCM certification within 1 Year required

Knowledge Skills and Abilities

Excellent verbal and written communication skills.
Proficient in Microsoft Word Excel and PowerPoint.

This position has a hiring range of : USD $102,606.00 - USD $196,996.00 /Yr.

Work Location: Hybrid remote in Columbia, MD 21044

Quick Apply

Refine Your Search

claims manager jobs in baltimore, md

RN Manager Grievances & Appeals

Payment Policy Manager (Hybrid)

NCQA Quality Manager (Hybrid)

Manager, Leave Administration & Workers' Compensation

Claims Supervisor

Project Manager - Insurance Restoration (AAction Home Repairs)

Property Manager (Multi-Building/Mixed Use Asset) – Hampton Plaza

Assistant Dental Office Manager

Regional Safety Manager

Case Manager/Paralegal

Healthcare Project Manager - (FACETS Claims Systems)

(i) Program Manager – Core Consolidation / FACETS Transformation

(ii) Technical Program Manager / Technical Delivery Manager – FACETS

Property Casualty Claims Manager

Pharmacy Program Manager (Hybrid)

Program Manager - Pharmacy Supply Chain - (Remote)

Telephonic Case Manager I

Manager, Technical Training

Multisite Business Office Manager

Account Manager-Claims Reporting

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