Claims Manager

Overview

AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!

Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?

If so, AIDS Healthcare Foundation is the place for you!

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

AHF’s core values are:

• Patient-Centered
• Value Employees
• Respect for Diversity
• Nimble
• Fight for What’s Right

Please review our Advocacy page for the latest news on how AHF is Fighting for What’s Right! Advocacy News.

Benefits at AHF

AHF offers comprehensive benefits to help our employees do and be their very best! These benefits are intended to enhance employee physical, financial, spiritual and professional health.

STILL INTERESTED? Please continue!

Responsibilities

The Claims Department Manager is responsible for overseeing the day-to-day operations of the health plan’s claims processing unit. This role ensures timely and accurate adjudication of claims, manages a team of claims examiners and support staff, and maintains compliance with regulatory and contractual obligations. The manager will also lead initiatives to improve operational efficiency, manage claim denials and appeals, and collaborate with internal departments and external providers to resolve complex issues.

The Claims Department Manager enhances the reputation of AHF by meeting key respobsibities as assigned by department management.

You will be a passionate advocate for our top initiatives.

To be successful as the Claims Department Manager , it is crucial to ensure that the AHF Core Values and Mission stay top of mind with all that you do. At AHF, we are nimble and able to adapt in a dynamic environment to assist in providing the best experience for our clients and workplace for our employees.

AHF has a collaborative organizational structure where staff are accountable to multiple leaders.

The Claims Department Manager will work as a part of a close-knit team to description

Key Responsibilities:• Team Leadership & Supervision• Manage, coach, and develop a team of claims examiners and department support associates. Monitor performance metrics and conduct regular performance evaluations. Foster a culture of accountability, collaboration, and continuous improvement.• Ensure timely and accurate processing of provider claims in accordance with plan policies and regulatory requirements Oversee daily inventory management to ensure workloads are balanced and service levels are met. Monitor and manage claim denials, rework, and appeals/disputes processes. Ensure compliance with all regulatory requirements.• Quality Assurance & Auditing• Implement and oversee internal audits to ensure claims accuracy and identify trends or training needs. Collaborate with the Quality and Compliance teams to address audit findings and implement corrective actions.• System & Process Management• Partner with IT and vendors to ensure claims system functionality, updates, and issue resolution. Identify and implement process improvements to enhance efficiency and reduce errors.• Provider & Stakeholder Relations• Serve as a liaison with providers to resolve claim disputes and ensure timely communication. Collaborate with Provider Relations, Member Services and UM/Medical Management to address cross-functional issues.• Reporting & Analytics• Generate and analyze operational reports to track productivity, turnaround times, and denial trends. Present findings and recommendations to leadership for strategic planning.• Other Duties• Perform other related duties and special projects as assigned to support departmental and organizational goals. Qulifications: 3-5 years of Claims Management experience preferred.

Qualifications

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment. AHF will consider qualified applicants with criminal histories in a manner consistent with the requirements of the ordinance.