Download Job Description (PDF)
Become a part of EMI Health’s growing organization. EMI Health is an employee benefits firm providing medical,
dental and vision insurance products to companies and individuals in 10 states. We provide our employees with
an outstanding benefit package that includes paid medical and dental coverage for employees, paid time off,
holiday pay, vision, life, disability, HSA and retirement savings plans. In addition, we provide our employees with a
fully equipped onsite fitness center and subsidize mass transit passes.
We are a tobacco free workplace, hiring non-tobacco users only.
EMI Health is an EEO employer as defined by the EEOC.
SUMMARY OF JOB:
Under the direction of the COO, the Claims Manager is responsible for managing the daily
activities of the Claims Department according to department and company policies and procedures. This is a full time, exempt position. Hours are generally 8:00 a.m. to 5:00 p.m. Monday through Friday.
- Oversees performance, productivity and quality standards of Claims staff.
Exhibits thorough working knowledge of medical, dental and vision claims.
- Oversees claim inventory and production to ensure that staff meet production standards and organizational
goals and adhere to all federal and state processing guidelines.
- Oversees development of claims policies, department training materials, audit processes and monitoring
- Oversees hiring, training and terminating staff.
- Supervises and directs the work of Claim Supervisors and Trainer.
- Evaluates claim processes and recommends process improvements.
- Prioritizes department tasks and delegates work assignments to accomplish department goals.
- Oversees the claims appeals inventory and review process.
- Resolves issues, questions and research items received from other departments.
Provides necessary reporting and recommendations to management.
EDUCATION, EXPERIENCE AND QUALIFICATIONS:
- Associates degree (Bachelors preferred) or minimum of five years related experience in a similar position;
or equivalent combination of training and experience.
- Working knowledge of claims payment systems.
- Thorough understanding of CPT, HCPCS, ICD9/ICD10 and other industry coding guidelines.
- Knowledge of terminology specific to medical, dental, and vision benefits.
Knowledge of State and Federal regulations related to the health insurance industry. (COB, Medicare,
COBRA, ACA, HIPAA, etc.)