Top 162 Insurance manager Jobs in Coconut Grove, Fl

Healthcare Claims and Fee for Service Supervisor
Provider Network Solutions LLC —Miami, FL
- $63,000 - $65,000 a year
- Full-time
- 5 years
- HIPAA
- Bachelor's degree
Quick Apply
8d
Sr. Customer Service Rep/Jr. Portfolio Manager (Deposit Portfolio)
Terrabank, N.A. —Coral Gables, FL
- Full-time
- Background check
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
Sales Manager - Aircraft Parts (Narrowbody)
Skyways Technics Americas LLC —North Miami, FL
- From $70,000 a year
- Full-time
- Background check
- ERP systems
- English
- Travel reimbursement
- Health savings account
Quick Apply
Commercial Lines Account Manager
WAHVE —Miami, FL
- Part-time
- Remote
- Senior level
- Marketing
- Commercial
- Health insurance
- 401(k)
Renewal Account Manager- ET, Remote
Warner Pacific Insurance Services —Miami, FL
- $30.26 - $40.35 an hour
- Overtime
- Remote
- 3 years
- High school diploma or GED
- Travel
- Paid holidays
- Disability insurance
Quick Apply
7d
Legal Office Manager
Kemper Insurance —Doral, FL
- Full-time
- Hybrid work
- Microsoft Word
- Microsoft Excel
- Research
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6d
Regional Sales Manager (South Florida)
Atradius —Miami, FL
- Up to $90,000 a year
- Full-time
- Mid-level
- Finance
- Business development
- Paid holidays
- Health insurance
Account Manager
BEST DOCTORS INSURANCE SERVICES LLC —Miami, FL
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Quick Apply
Commercial Lines Account Manager
Impact Performance Team —Miami, FL
- $75,000 - $100,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
- Disability insurance
- Health insurance
Quick Apply
Risk Manager
Watsco, Inc —Coconut Grove, FL
- Hybrid work
- Office
- 3 years
- Math
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Risk Manager
Watsco —Coconut Grove, FL
- Full-time
- Hybrid work
- Office
- 3 years
- Math
HR Reinvention Consulting Manager, Insurance
Accenture —Miami, FL
- $87,400 - $293,800 a year
- Full-time
- Oracle
- Writing skills
- Presentation skills
- Paid holidays
- Disability insurance
12d
Client Service Manager
Gallagher —Miami, FL
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
Personal Lines Account Manager
Impact Performance Team —Miami, FL
- $65,000 - $85,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- 2 years
- Disability insurance
- Health insurance
Quick Apply
Account Manager - State Farm Agent Team Member
Lexi Goza - State Farm Agent —Miami, FL
- $70,000 - $90,000 a year
- Full-time
- No experience needed
- Office
- Leadership
- Health insurance
- Dental insurance
Quick Apply
13d
Account Manager- Employee Benefits
Insurance Office of America, Inc. —Coral Gables, FL
- $55,000 - $70,000 a year
- Full-time
- Microsoft Outlook
- 5 years
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
13d
Commercial Lines Sales Manager - Florida
Arbol —Miami, FL
- $100,000 - $140,000 a year
- Full-time
- Remote
- Clean driving record
- Office
- Driver's License
- Health insurance
- Dental insurance
Quick Apply
Manager | Sales Reinvention | Insurance
Accenture —Miami, FL
- $87,400 - $253,000 a year
- Full-time
- US work authorization
- Military encouraged
- Agile
- Paid holidays
- Disability insurance
Integration Manager – M&A (Florida)
Insurance Office of America, Inc. —Coral Gables, FL
- $100,000 - $130,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- 8 years
- Paid holidays
- Health insurance
Quick Apply
5d
Account Manager - State Farm Agent Team Member
Lakitsia Gaines - State Farm Agent —Miami, FL
- $60,000 - $80,000 a year
- Full-time
- Spanish
- Mid-level
- Office
- Health insurance
- Paid time off
Quick Apply

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insurance manager jobs near coconut grove, fl

Healthcare Claims and Fee for Service Supervisor

Provider Network Solutions LLC -
Miami, FL

Quick Apply

Job Details

Full-time
$63,000 - $65,000 a year
8 days ago

Qualifications

X12 EDI
Healthcare dispute resolution
Staff supervision
Process audits
EDI
Medicare
Team supervision
Medicare coding guidelines
Payment processing
Standard Operating Procedures (SOPs) implementation
Insurance dispute resolution
Overseeing healthcare denial management
Coaching
CMS
Regulatory compliance in claims processing
AI tools proficiency
HIPAA
Performance management
Medical claims processing software
CMS regulatory compliance
Policy & process development
Health insurance knowledge
Medicare regulations
Decision making
System testing
Payment posting in medical billing systems
Technical writing
Interdisciplinary policy and procedure development experience
Insurance investigations
Centers for Medicare & Medicaid Services (CMS) billing regulations

Full Job Description

Description:

Position Summary

The Claims and Fee for Service Supervisor manages the operational activities and staff of the Claims and Revenue Cycle Department in accordance with the Company guidelines, client needs, and State and Federal requirements.

Duties and Responsibilities

Oversee and manage daily activities and functions of the Claims Examiners processing claims for services that are capitated and Fee for Service with the health plan.
Responsible for overseeing the Revenue Cycle Management and Claims department’s daily operations, including but not limited to, running daily/frequent reports to ensure claims are processed timely, accurately, and in compliance with all federal and state healthcare plan laws and regulations. As well as, posting of all 835 payments.
Develop, implement, and update Claims Policies and Procedures to ensure compliance with CMS, Medicaid, HIPPA regulations, and health plan requirements.
Report overpayments, underpayments, and other irregularities.
Manage and close out claims open tickets and provider claims disputes.
Ensure optimal handling of all claims, investigate claims issues, and provide claims training for all business units.
Work together with Provider Servicing and participate in provider education, as necessary.
Maintain a fully comprehensive understanding of the covered benefits, coding, and reimbursement policies and contracts.
Act as Subject Matter Expert in issues related to claims processing, payment dispute resolution, cost containment, audit processes, and contract interpretation.
Actively collaborate with management and staff to ensure that “best practices” are followed and continually seek efficient and innovative processes, technologies, and approaches to optimize the use of resources and enhance operations.
Conduct analysis around various claims payment processes to ensure accuracy of system configuration and provider payments.
Investigate and resolve problem claims, while focusing on improving errors and problems to prevent future occurrences.
Perform and execute various claims process testing requests to ensure desired results are met to support accurate claims payments.
Analyze and adjudicate complex claims when examiner is requesting Supervisor review.
Adjudicate claims by, including but not limited to, applying medical necessity guidelines, determining coverage and completing eligibility verification, identifying discrepancies and applying all cost containment measures when necessary.
Process medical claims by approving or denying documentation, calculating benefits due initiating a payment or denial letter when necessary.
Follow any center for Medicare and Medicaid (CMS) changes affecting claims processing.
Perform pre-payment audit and payment cycle.
Complies with performance standards as set forth by the department head.
Follow company policies, procedures, and guidelines to ensure legal compliance.
Update claims knowledge by participating in educational opportunities, whether system oriented or medical coding/terminology/interpretation.
Update and maintain departmental and specialty network standards of operating procedure (SOP).
Regularly meet with VP of Operations - to discuss and resolve reimbursement issues or billing obstacles.
Perform one-on-one meeting with the individual staff members.

Requirements:

Knowledge

Bachelor’s degree in health administration, Business, or a related field (or equivalent experience).
5+ years of experience in healthcare claims processing, Revenue Cycle Management, or medical billing; 2+ years in a supervisory or lead role preferred.
Strong understanding of CMS, Medicare, Medicaid, HIPAA, and healthcare compliance standards.
Proficiency with medical coding systems (ICD-10, CPT/HCPCS) and claims adjudication platforms.
Experience with payment posting, audits, dispute resolution, and claims system testing/UAT.
Experience using AI applications to streamline claims processing, improve accuracy in claim evaluations, and enhance decision-making efficiency.

Skills

Analytical & problem-solving skills to resolve complex claims, identify root causes, and ensure accurate payments.
Leadership & supervisory skills for managing daily operations, coaching staff, and conducting performance meetings.
Strong communication abilities to collaborate with providers, internal teams, and senior leadership.
Process & policy development skills, including writing SOPs, implementing best practices, and ensuring regulatory compliance.
Technical proficiency in claims platforms, RCM systems, Excel/reporting, and conducting system/UAT testing.

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Refine Your Search

insurance manager jobs in coconut grove, fl

Healthcare Claims and Fee for Service Supervisor

Sr. Customer Service Rep/Jr. Portfolio Manager (Deposit Portfolio)

Sales Manager - Aircraft Parts (Narrowbody)

Commercial Lines Account Manager

Renewal Account Manager- ET, Remote

Legal Office Manager

Regional Sales Manager (South Florida)

Account Manager

Commercial Lines Account Manager

Risk Manager

Risk Manager

HR Reinvention Consulting Manager, Insurance

Client Service Manager

Personal Lines Account Manager

Account Manager - State Farm Agent Team Member

Account Manager- Employee Benefits

Commercial Lines Sales Manager - Florida

Manager | Sales Reinvention | Insurance

Integration Manager – M&A (Florida)

Account Manager - State Farm Agent Team Member

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