Partner with management in the design, implementation and maintenance of claims processing programs and procedures. Verify that claims are being adjudicated or submitted according to Magellan contracts in a consistent and accurate manner. Manage projects and administrative duties as required by business need. Lead and implement positive changes with a high level of quality and professionalism.

• Adjudicate or submit claims and adjustments as required.

• Track and trend performance of root cause analysis and provide additional training as needed.

• Resolve claims edits and suspended claims.

• Maintain and update required reference materials to adjudicate or submit claims.

• Continuously identify process improvements that impact quality and service results; recommend solutions.

• Provide backup support to other team/group members in the performance of job duties as assigned.

• Serve as a resource (buddy) for newly hired associates and/or assist with remedial training for existing associates as needed. Prepare feedback and review for Supervisors and Managers.

• Handle all types of requests, inquiries and complaints accurately and timely, to include written correspondence and phone inquiries from internal customers.

  Other Job Requirements

Responsibilities

Ability to quickly use a 10-key machine.

Excellent command of ICD-9/10 codes and Current Procedural Terminology (CPT).

Excellent decision making, analytical, organizational, presentation, communication (verbal and written), coaching and leadership skills.

Demonstrated reading comprehension and ability to follow provided directions.

General Job Information

Title

Lead Claims Processor

Grade

21

Work Experience - Required

Claims

Work Experience - Preferred

Education - Required

Education - Preferred

Bachelor's

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:

$45,655

Salary Maximum:

$68,485

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.

Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.

Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .

Warning: Employment Scam

It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.

Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.

If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911