At TEKsystems, we are working with a local company seeking a Claims Manager who will oversee claims processing operations, ensuring accuracy, efficiency, and regulatory compliance. This role requires a thorough understanding of claims systems, management skills, and the ability to drive process improvements. The Claims Manager will manage both onshore and offshore vendor relationships to ensure seamless operations across all lines of business, including Medicare, Medicaid, and commercial insurance. Interested candidates are encouraged to apply, and a recruiter will contact you.
Key Responsibilities:
- Claims Processing: Oversee end-to-end claims processing operations, with experience in Claims systems (QNXT).
- System Implementation: Integrate Cotiviti, track testing, and incorporate into workflows.
- Vendor Management: Manage offshore vendor relationships, ensuring quality and efficiency.
- Compliance: Ensure all activities comply with relevant regulations.
- Operations Improvement: Identify and implement process enhancements.
- Team Management: Lead and mentor ICT testers and liaisons.
- Reporting: Develop reports on claims metrics, trends, and improvements.
- Collaboration: Work with IT, customer service, and finance teams for seamless operations.
Qualifications:
- Bachelor's degree in Healthcare Administration, Business, IT, or related; Master's preferred.
- Must have Medicare/Medicaid claims process knowledge.
- Leadership skills, organizational skills, problem-solving ability, risk management, adaptability, proficiency in Microsoft Office, strong communication, and documentation skills.
- Must be located in Hawai'i .
Pay and Benefits:
Range: $38.00 - $51.00/hr. Benefits include medical, dental, vision, 401(k), life insurance, disability, HSA, transportation, employee assistance, and PTO. Eligibility depends on job classification and employment duration.
Workplace Type: Fully onsite in HONOLULU, HI.
Application Deadline: June 29, 2025.
About TEKsystems:
We partner in transformation, helping clients activate ideas and solutions. With 80,000 employees, we serve over 6,000 clients, including 80% of the Fortune 500, across North America, Europe, and Asia. TEKsystems is an Allegis Group company, committed to diversity and equal opportunity.
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