Claims Benefit Manager overseeing medical adjudication operations at Hive Health. Leading a team to ensure compliance and optimize claims processing in a hybrid work environment.
Responsibilities
Lead and manage the medical liaisons team to meet accuracy, quality, and service targets
Oversee daily adjudication operations to ensure claims are processed efficiently and in compliance with policy guidelines
Conduct audits to ensure claims accuracy, completeness, and consistency with internal standards
Identify potential cases of fraud, waste, or abuse (FWA) and coordinate investigations with Legal and Compliance
Work cross-functionally with Claims, Provider Partnerships and Healthcare Services to address recurring operational issues
Monitor key metrics such as turnaround time, quality scores, and error rates, and implement corrective measures as needed
Drive continuous process improvements to enhance provider and member experience in the claims process
Requirements
Bachelor’s degree in nursing, healthcare management, business, or a related field
At least 5 years of experience in operations, healthcare administration, or team management
Strong analytical and problem-solving skills, with a focus on process improvement
Experience leading teams and driving performance in fast-paced environments
Comfortable working with data, reports, and digital systems to track metrics and quality outcomes
Excellent communication and stakeholder management skills across both medical and non-medical teams
Benefits
comprehensive healthcare coverage for you and your dependent
paid time off from the start
mentorship, career development, and learning opportunities
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