Top 282 Claims manager Jobs in Gilbert, Az

Claims Oversight & Compliance Manager
Arizona Priority Care —Chandler, AZ
- $100,000 - $110,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- 5 years
- Office
3d
Property Manager
Avenue5 Residential, LLC —Tempe, AZ
- $90,000 a year
- Full-time
- Clean driving record
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Health insurance
Quick Apply
10d
Workers Compensation Claims Manager
AmTrust Financial Services, Inc. —Scottsdale, AZ
- Urgently hiring
- Hybrid work
- Management
- Mid-level
- Office
- Health insurance
- Dental insurance
Commercial Account Manager
Premier Choice Insurance —Mesa, AZ
- $65,000 - $80,000 a year
- Full-time
- Mid-level
- Office
- In-person
- Paid holidays
- Health insurance
Quick Apply
Personal Lines Account Manager - Independent Retail Insurance
ALKEME Insurance —Chandler, AZ
- Full-time
- Mid-level
- Office
- 3 years
- Paid holidays
- Health insurance
Quick Apply
22h
Revenue Cycle Operations Manager
Denova Collaborative Health —Phoenix, AZ
- Full-time
- Hybrid work
- Microsoft Excel
- 5 years
- Office
- Wellness program
- Paid holidays
Quick Apply
Commercialization Manager
SunTree Snack Foods —Phoenix, AZ
- $95,000 a year
- 8 hour shift
- Mid-level
- Microsoft Office
- Project management
- Health insurance
- Dental insurance
Quick Apply
1d
Swimming Pool Service Manager
Barefoot Pools, LLC. —Gilbert, AZ
- From $60,320 a year
- Full-time
- Mid-level
- Team management
- Recruiting
- Health insurance
- Paid time off
Quick Apply
Telehealth Medical Clinic Manager
Envita Medical Centers LLC —Scottsdale, AZ
- Full-time
- Master's degree
- Bachelor's degree
- Senior level
- Health insurance
- Dental insurance
Quick Apply
Collision Center Manager
Confidential —Phoenix, AZ
- From $144,000 a year
- Full-time
- ASE Certification
- Background check
- Clean driving record
- Paid holidays
- Health insurance
Quick Apply
General Manager-Long Tern Care Pharmacy
KORMAN HEALTHCARE —Chandler, AZ
- From $73,000 a year
- Weekends as needed
- Background check
- OSHA
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
3h
Global Compressor Category Manager
Smardt —Phoenix, AZ
- Full-time
- Inventory management
- Experience equivalent to degree accepted
- Senior level
- Health insurance
- Dental insurance
Quick Apply
Personal Injury Case Manager
Hastings & Hastings, P.C. —Chandler, AZ
- Full-time
- Customer service
- Computer literacy
- English
- Health insurance
- Dental insurance
Quick Apply
Apartment Property Manager #824
Cal-Am Properties Inc —Gilbert, AZ
- $67,000 a year
- Full-time
- Clean driving record
- Mid-level
- Residential
- Health insurance
- Dental insurance
Quick Apply
Sr. Project Manager (Mechanical)
RimePro Inc —Phoenix, AZ
- $120,000 - $150,000 a year
- Full-time
- 11+ years
- Mentoring
- Contracts
Quick Apply
RCM Billing Manager
American Vision Partners —Phoenix, AZ
- Full-time
- Microsoft Outlook
- Surgery
- Customer service
- Paid holidays
- Health insurance
Community Association Manager / Portfolio (PAZ61626)
RealManage —Phoenix, AZ
- $60,000 - $70,000 a year
- Full-time
- Microsoft Outlook
- Mid-level
- Office
- Health savings account
- Paid holidays
Quick Apply
HSE MANAGER
Nox Group —Phoenix, AZ
- Overtime
- Background check
- CPR Certification
- Construction site
Quick Apply
Senior Project Manager - Heavy Civil
Everforth —Phoenix, AZ
- $125,000 - $175,000 a year
- Full-time
- Civil engineering
- Construction site
- Master's degree
- Paid holidays
- Dental insurance
Quick Apply
Claims Manager, Workers Compensation
Starr Companies —Scottsdale, AZ
- From $250,000 a year
- Full-time
- Office
- Team management
- Organizational skills
4d

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claims manager jobs near gilbert, az

Claims Oversight & Compliance Manager

Arizona Priority Care -
Chandler, AZ

Apply Now

Job Details

Full-time
$100,000 - $110,000 a year
3 days ago

Qualifications

Computer operation
Contract management
Staff supervision
Microsoft Excel
Customer relationship building
Medicare
Health insurance policy knowledge
CMS
Regulatory compliance in claims processing
Contract management experience in healthcare
CMS regulatory compliance
Math
Medicare regulations
Data interpretation
Presentation preparation
Centers for Medicare & Medicaid Services (CMS) billing regulations
Productivity software
Medical terminology

Full Job Description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Claims Oversight and Compliance Manager ensures that claims processing aligns with federal and internal regulations. They conduct audits, develop Corrective Action Plan (CAP) responses, manage compliance reporting, health plan audits, and oversight of claims processing.

POSITION DUTIES & RESPONSIBILITES

Data validation and submission of all health plan reports and deliverables
Prepare and present audit packets for health plan audits
Point of contact for health plan inquiries
Interpret and implement timely updates to member denial letters, EOBs, and provider letters
Develop CAP responses and ensure that changes are implemented timely and appropriately
Regularly review claims processing, billing, and coding to identify compliance gaps and risks
Oversight of audit functions for offshore teams
Oversight of all adjustment functions and reporting
Ensures appropriate monitoring of PDR logs, provider inquiries, and call logs for timely completion
Maintains contract rates in EZ Cap for appropriate claims adjudication
Coordinates with Claims Manager regarding audit findings to ensure appropriate education and training is provided to Examiners
Oversight of Audit and Adjustment teams to ensure timely review and adjustment of claims
Coordinates requests for contract updates and system configuration.
Collaborates with various departments to ensure system, documentation, and processes are up to date for appropriate claims adjudication.
Ensure that departmental standards and timelines are met within each unit.
Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
Perform other duties as assigned

EDUCATION, TRAINING AND EXPERIENCE

Bachelor’s degree in healthcare administration or related field or equivalent work experience
Minimum 5+ years in health plan/IPA claims processing, audit, or compliance roles
Minimum 5+ years management experience
Knowledge of Medicare rules, medical terminology, and managed care health plan rules and regulations, CPT, HCPCS, ICD-10, RVS codes
Thorough understanding of claims operations to include payment of claims, interpretation of contracts; communication of benefits and eligibility
Ability to draw upon knowledge and experience to anticipate issues, potential risks, implications, and changes to Medicare
Strong math and analytical skills, including the ability to analyze and organize data
Excellent ability to build and maintain business relationships with providers by providing prompt and accurate service
Strong attention to detail
Proficiency in Microsoft Office products, including Power Point, Word, and Excel
Demonstrated strong organizational, analytical, oral presentation, written communications, decision-making skills and leadership skills
Must be able to work under general guidance of Claims Director with little direct supervision
Strong knowledge of Medicare Billing & Payment Guidelines as well as CMS CCI Edits
Familiar with all regulatory requirements including CMS
Strong attention to detail
EZ-Cap Experience is a plus
Must be able to work independently, exercise judgment and communicate effectively.
Must be able to work on computer systems, accessing multiple files and programs.

*This role requires 60 days FT in office presence, hybrid options will be available after the 60-day period.*

Compensation range: The salary range for this position is: $100,000 – $110,000.

Apply Now

Refine Your Search

claims manager jobs in gilbert, az

Claims Oversight & Compliance Manager

Property Manager

Workers Compensation Claims Manager

Commercial Account Manager

Personal Lines Account Manager - Independent Retail Insurance

Revenue Cycle Operations Manager

Commercialization Manager

Swimming Pool Service Manager

Telehealth Medical Clinic Manager

Collision Center Manager

General Manager-Long Tern Care Pharmacy

Global Compressor Category Manager

Personal Injury Case Manager

Apartment Property Manager #824

Sr. Project Manager (Mechanical)

RCM Billing Manager

Community Association Manager / Portfolio (PAZ61626)

HSE MANAGER

Senior Project Manager - Heavy Civil

Claims Manager, Workers Compensation

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