Claims Management Specialist

Claims Management Specialist

Are you a seasoned medical insurance professional with a passion for leadership and operational excellence? FlexStaff is seeking a dynamic Claims Management Specialist for our client to oversee their Medicare, Medicaid, and Out-of-Network Insurance operations in beautiful Chappaqua, NY. If you thrive in a fast-paced environment, excel at team management, and have deep expertise in healthcare insurance billing, this is your chance to make a meaningful impact!

Join the team and lead a dedicated group of insurance specialists, ensuring claims are processed accurately and efficiently while maintaining full compliance with government regulations. Bring your leadership skills, industry knowledge, and innovative mindset to help us deliver exceptional service and operational success.

Responsibilities:

- Lead and manage a team of insurance specialists handling Medicare, Medicaid, and out-of-network claims.

- Monitor daily workflows to ensure timely and accurate claim submission, follow-up, and resolution.

- Serve as a subject matter expert on government payer policies, billing guidelines, and regulatory changes.

- Collaborate with internal departments such as billing, coding, and patient services to resolve complex claim issues.

- Implement and oversee training programs to enhance team knowledge and performance.

- Track and report on key performance indicators (KPIs), identifying trends and areas for improvement.

- Foster a positive, collaborative team environment through coaching, feedback, and performance management.

Qualifications:

- Minimum of 3-5 years of experience in medical insurance billing and claims management, with a focus on Medicare, Medicaid, and Out-of-Network payers.

- Prior leadership or supervisory experience preferred.

- Strong understanding of insurance regulations, EDI transactions, and denial management.

- Proficiency with healthcare billing software and Microsoft Office Suite.

- Excellent communication, problem-solving, and organizational skills.

- Ability to work independently and manage multiple priorities in a dynamic environment.

*Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts,