Job Description

RESPONSIBILITIES & AUTHORITY

Manage a Claims/Customer Service Department of 6-8 full-time employees; ensure accurate and timely claim processing; resolve complex claim issues; respond to claim appeals, supervise medical necessity reviews, ensure high-quality customer service; oversee claim negotiations, help manage vendor applications (TriZetto, Zelis, SDS, PPO networks, utilization review management, etc.); ensure compliance with applicable regulatory requirements; and provide managerial support for other responsibilities duties as necessary.

REQUIREMENTS & QUALIFICATIONS

PROFESSIONAL:  Bachelor’s or Associate’s degree or a high school diploma and exceptional work experience.

EXPERIENCE:    Minimum 10 years health insurance or TPA experience with at least five years managerial experience.  Strong knowledge of medical claims processing and insurance benefit management.  Proficient in Excel, Word and other Microsoft Office products.  Experience with TriZetto QicLink software a plus.

PERSONAL:        Judicious managerial ability; strong communication, verbal, written, time management, and workflow analysis skills; fair and careful judgment, loyal and long-term employment commitment.

SALARY & BENEFITS

Position salary is commensurate with experience and includes a generous benefit package (health insurance, dental, vision, life, short-term disability, paid time off, and SEP pension).

Background check required.

Company Description

WMI Mutual Insurance Company is a small health insurance company located in Taylorsville, Utah. WMI has been insuring employer groups in several western states for 30 years and is seeking to expand its presence in the Medicare Supplement insurance market. WMI TPA is a third-party administrator that administers self-funded health benefit plans for mid-sized employers.