Partner with management in the design, implementation and maintenance of claims processing programs and procedures. Verify that claims are being adjudicated or submitted according to Magellan contracts in a consistent and accurate manner. Manage projects and administrative duties as required by business need. Lead and implement positive changes with a high level of quality and professionalism.

• Adjudicate or submit claims and adjustments as required.
• Track and trend performance of root cause analysis and provide additional training as needed.
• Resolve claims edits and suspended claims.
• Maintain and update required reference materials to adjudicate or submit claims.
• Continuously identify process improvements that impact quality and service results; recommend solutions.
• Provide backup support to other team/group members in the performance of job duties as assigned.
• Serve as a resource (buddy) for newly hired associates and/or assist with remedial training for existing associates as needed. Prepare feedback and review for Supervisors and Managers.
• Handle all types of requests, inquiries and complaints accurately and timely, to include written correspondence and phone inquiries from internal customers.

Other Job Requirements

Responsibilities Ability to quickly use a 10-key machine. Excellent command of ICD-9/10 codes and Current Procedural Terminology (CPT). Excellent decision making, analytical, organizational, presentation, communication (verbal and written), coaching and leadership skills. Demonstrated reading comprehension and ability to follow provided directions.

*General Job Information*

Title Lead Claims Processor

Grade 21

Work Experience - Required Claims

Work Experience - Preferred

Education - Required

Education - Preferred Bachelor's

License and Certifications - Required

*License and Certifications - Preferred*

Salary Range

Salary Minimum: $45,655 Salary Maximum: $68,485

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity