Sr. Manager, Insurance Management Claims

hace 12 horas

Alajuela, Costa Rica Smiledirectclub A tiempo completo

**Job Type**: Full-Time Overview:
As part of the Insurance Management team, the Sr.
Manager, Insurance Management

Claims & Insurance Partner Success will focus on helping the team by providing inspired leadership for the Insurance Management line of business, which involves making important policy and strategy decisions based on the insurance projects, as well as the development and implementation of operational policies and procedures in the claims processing and collections processes.
Must be familiar with all accounting procedures and capable of managing the complete financial process from claim submission to payment posting.
Must be capable of developing and handling insurance partnership relationships to provide the best experience to our club members while maximizing value for SDC.
**Responsibilities**:

- Sets clear strategic direction to Claims & Collections team to effectively submit, follow up and collect claims on behalf of SDC and its customers and constantly improve the revenue cycle process.
- Responsible for collecting insurance claims from multiple US/International based insurance companies with an average of $8-10 million per year
- Manages a team of 5 - 10 Claims & Collections Specialists in charge of revenue cycle management and accounts receivable
- Sets regular weekly and monthly deadlines to process the payment and accounts
- Prepares timely reports on regular intervals (monthly, quarterly, and annual) making forecasts on payment flow for internal and external use
- Oversees the processing and organizing of claim bills, records and invoices ensuring quality and compliance at every step
- Ensures that all practices comply with company, industry, and regulatory standards such as SOX, HIPAA, GAAP, etc.
- Develops effective partnerships with US and global insurance companies to find new opportunities to provide more value to our club members, negotiate disputes and appeals and settle non-payment disputes.
- Keeps in touch with the industry's best practices and continuously implements improvements
- Collaborates with our other teams to identify opportunities to solve problems or implement new enhancements to systems and processes
- Ensures the proper allocation and most effective use of team resources by establishing key performance indicators such as team efficiency, utilization, and capacity.
- Claims and collections SME owning the end-to-end process and serving as business product owner for underlying technology stack
- Capable of understanding and executing insurance contracts
- Responsible for metrics such as: clean claim rate, new claim aging, claim denials, bad debt, A/R aging

Qualifications:

- A bachelor's degree in business administration, accounting, finance, or related field
- Five to eight years of accounting experience, CPA certification is a plus.
- English proficiency B2+ or C1 (written and spoken) is required
- Experience working in hospital/dental insurance customer service and accounts receivable companies is strongly desired
- Demonstrated leadership skills with specific examples of coaching and developing teammates
- Strong proficiency in MS Office products such as Excel, Word, and PowerPoint with experience working with accounting, general ledger, and accounts receivable software packages.
- Demonstrated communication skills in verbal and written form
- Adaptable to change in a goal-oriented environment
- History of working independently and taking initiative
- Able to create and develop strategic partnerships with external parties
- Great positive attitude and being a team player
- Strong interpersonal and communication skills to interact with employees, superiors, and payors.
- Strong analytical and time management skills
- Good presentation skills
- Well planned, organized with keen attention to detail

Company Profile:
SmileDirectClub was founded on a simple belief: everyone deserves a smile they love.
The Company is the first digital brand for straightening your smile, created after the realization that recent trends in 3D printing and telehealth could bring about disruptive change to the invisible aligner market by matching licensed professionals, a quality clear-aligner product, and customers together.
By leveraging proprietary, cutting-edge technology, SmileDirectClub, LLC-affiliated dentists are providing greater access of care to consumers who couldn't otherwise afford orthodontic treatment to get a better smile.
- What is SmileDirectClub?
Link here.
- What are our customers saying?
Link here.
- What is a SmileShop?
Link here.
- What is our culture like?
Link here.
- How do we celebrate your team members?
Link here.

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