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Claims Manager

Operations | Miami, FL | Full Time

Job Description

About Us:

We are a service-based company and as a licensed third party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach.

We are looking for a Claims Supervisor that manages day-to-day claims operations, including claims evaluation, adjudication and customer service in accordance with agreed quality and production standards. Process claims in a timely manner and complies with industry fair claims practices and applicable state regulations concerning the processing of claims. Sets goals, while being accountable for the results. Manages staff of claims professionals, includes claims examiners, Concierge/ Customer Service specialist and support personnel, including the regular and timely evaluation of their performance. Maintains good, professional working relationship with superiors, peers, subordinates and other department managers and personnel. 

  • In conjunction with HR, interview, hire, train and personnel. 
  • Supervise, motivate and monitor the staff to ensure compliance with claims procedures and standards.
  • Utilize control system and procedures to maximize productivity.
  • Review any difficult or special cases. Mentor the professional development and skills of the staff 
  • Explain eligibility process, procedures , actions or contract interpretation to management staff within the claims department and to internal customers (Customer Service, IT, Ect.) 
  • Keep staff current about company, department and organizational issues, in addition to claims eligibility issues or procedures. This will be done via regular departmental meetings, one-on one  communications and distribution of written directives. 
  • Advise management of any issues raised by staff and suggest actions that will improve processing or resolve the issues. Notify management on eligibility issues. 
  • Additional duties assigned from time to time. 


Knowledge of medical claims coding, different medical specialties and medical services billed for payment by providers to insurance companies is a must.

Bonus Points:

  • PayerFusion provides competitive compensation. Base compensation commences with experience, and knowledge of the claims administration industry.
  • PayerFusion provides competitive benefits that include vacation, holiday, sick-time as well as health insurance and other corporate benefits.