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Needs Manger (Remote, US)

United States

About the Role:

As the Needs Manager, you will oversee the daily management of staff, support internal departments, and assist in adjudicating Needs for our Healthshare plans, ensuring compliance with company policies and regulations. You will ensure the timely and accurate processing of Needs while managing production and financial goals. This role requires investigative skills to resolve complex issues, provide staff training and support, and ensure departmental efficiency. The ideal candidate should have a deep understanding of Healthshare plans, claims adjudication, and benefit interpretation. Strong leadership, multitasking abilities, and effectiveness in a fast-paced environment are essential for success.The Needs Manager is a hands-on leader, both managing the team and actively contributing to daily tasks.

Role Responsibilities:

  • Accurately adjudicate CMS 1500 and UB-04 Needs for Healthshare plans. Since Needs are submitted similarly to claims, familiarity with claims processing and coding is crucial
  • Review medical documentation for Needs to determine if they are shareable under the Healthshare plan
  • Conduct audits on processed Needs to ensure accuracy and compliance
  • Research and process complex Needs within the Healthshare program
  • Engage in provider and member outreach to gather necessary documentation for processing Needs requests
  • Provide both new and ongoing staff training
  • Manage and support the daily operations of the Needs staff
  • Develop and maintain policies and procedures for Needs processing
  • Recalculate Needs as required due to incorrect payments or additional information
  • Investigate and resolve discrepancies and other issues promptly
  • Stay updated on industry standards, regulations, and company policies related to Needs processing
  • Thoroughly document actions and decisions in the processing system
  • Collaborate with team members to enhance efficiency and streamline processes
  • Lead and participate in training sessions, ensuring staff is up-to-date with procedural and guideline changes

Key Competencies:

  • 2+ years of management experience required
  • 3+ years of experience in Needs and/or claims processing for both traditional health insurance plans and Healthshare plans required
  • Strong understanding of general claims processing principles, CMS coding, and UB-04 claims coding
  • Knowledge of CPT, HCPCS, dental, and diagnosis coding
  • Excellent data entry, analytical, and problem-solving skills
  • Ability to interpret and apply benefits to claims and Needs based on specific plan guidelines
  • Strong attention to detail and accuracy in all tasks
  • Proficiency in claims processing software and systems (IPS nice to have)
  • Ability to work independently and collaboratively in a team environment
  • Strong organizational skills with the ability to manage multiple tasks and meet deadlines
  • Familiarity with healthcare regulations and compliance requirements
  • Strong customer service orientation with the ability to handle inquiries and resolve issues professionally
  • Excellent verbal and written communication skills, fluency in English
  • Legally authorized to work in the US

All new hires must successfully pass a background screening as part of the onboarding process.

 

The compensation for this position depends on experience, skills, qualifications, location, and competencies. We are a remote first organization with employees in 25 states and 5 countries and growing! We offer competitive compensation, bonus’, and benefit packages, PTO (unlimited or 3 weeks accrued depending on the role) as well as a 401K match and regularly review these to align with industry standards. We also offer new employees a one time work from home reimbursement to set up your home office. 

Pay Range

$70,000 - $80,000 USD

About Us:

Better plans, better benefits, and better prices. Clearwater is a cutting edge InsurTech company headquartered in Austin, TX, the city known for its unicorns, tech giants, food scene, weirdness, and never-ending heat. Our team of innovators, operators, and healthcare veterans were determined to drive major change in our industry, once and for all. Whether you are seeking benefits as an individual, your family, or your business, we have the right plan, at the right price, with total transparency—even if it’s not one of our exclusive offerings.

We are committed to fostering an inclusive environment where all employees feel valued, respected, and supported. We actively promote diversity in all its forms and strive to create equitable opportunities for everyone regardless of race, ethnicity, gender, sexual orientation, age, disability, religion, or any other characteristic protected by law.

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