• Medicare Claims Manager

    TEKsystems (Honolulu, HI)


    Medicare Claims Manager

     

    Must live on Oahu, Honolulu | Hybrid, 1-2 days onsite

     

    Monday to Friday | 6 months contract to hire, FTE

    Description

    The Claims Manager will oversee the claims processing operations, ensuring accuracy, efficiency, and compliance with regulatory requirements. 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 and ensure seamless operations across all lines of business, including Medicare, Medicaid, and commercial insurance.

    Key Responsibilities:

    Claims Processing: Oversee the end-to-end claims processing operations, ensuring timely and accurate adjudication of claims.

     

    Vendor Management: Manage relationships with offshore vendors, ensuring quality and efficiency in claims processing.

     

    Compliance: Ensure all claims processing activities comply with federal, state, and local regulations.

     

    Operations Improvement: Identify and implement process improvements to enhance operational efficiency and accuracy.

     

    Team Management: Lead and mentor a team of ICT testers and claims processors, providing guidance and support to achieve departmental goals.

     

    Reporting: Develop and maintain reports on claims processing metrics, identifying trends and areas for improvement.

     

    Collaboration: Work closely with other departments, including IT, customer service, and finance, to ensure seamless operations and resolve any issues.

    Required Skill Sets and Level of Competency:

    • Leadership – Setting a positive example, providing guidance, resolving conflicts, and fostering a collaborative and productive work environment.

    • Organizational Skills – Ability to create and manage project plans, timeliness, budgets, and resources.

    • Problem Solving – Ability to identify problems, analyze their root causes, and developing effective solutions to keep the project progressing.

    • Risk Management – Ability to assess, mitigate, and manage risks proactively and preventing risks from becoming issues.

    • Adaptability – Ability to adjust to changes in scope, priorities, requirements, and other unknown situations/escalations that arise in operations.

    • Intermediate knowledge of Microsoft Office Suite (Excel, PowerPoint, Word, Outlook).

    • Strong verbal and written communication skills for interacting with team members, stakeholders, vendors, executives.

    • Documentation Skills – Maintaining accurate and up-to-date project documentation such as tracking progress, decisions, and changes which are critical in ensuring accountability. This includes ability to develop Dashboards that show keep metrics and pulse of the operational area(s).

     

    Skills

     

    healthcare insurance, medicare, medicare claims, medicaid programs, medicare enrollment, vendor management, claims systems, management, healthcare operations, qnxt

    Pay and Benefits

    The pay range for this position is $38.00 - $51.00/hr.

     

    Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

     

    • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

     

    Workplace Type

     

    This is a fully onsite position in HONOLULU,HI.

     

    Application Deadline

     

    This position is anticipated to close on May 21, 2025.

    About TEKsystems and TEKsystems Global Services

    We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

     

    The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.