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Digital Healthcare Payments

Director/Manager of Claims Processing

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About Us

Flume Health helps employers make their health plans more affordable and easier to use. We work with self-insured companies as their health administrator (TPA), replacing the incumbent insurance carrier. In doing so, we are reinventing what it means to have “health insurance” - from the app members use to find a doctor, to the payments happening in the background.

Our flagship product is “Flume Pay” which allows us to reimburse healthcare providers in under 72 hours - giving us 20-40% discounts on medical services (typical cycle is 4-6 weeks); we then pass these savings onto our customers. Flume Pay is a pioneering method for medical payments and our vision is to make it the ubiquitous standard for the $1T+ spent on healthcare services every year.


The Role

The Claims Manger manages of the claims process from initial submission to final payment of all claims for the plans that Flume Health administers.

The Claims Manager manages medical claims adjudication and third-party administrator (TPA) operations, including claims processing and management, and payment and plan billing. Claims management includes management of direct submitters, paper-to-EDI providers and clearinghouses; coordination of prior authorizations; and oversight of the flow of claims from FW&A to editing and repricing to adjudication and audit review to payment and billing.


What You'll Do

Specific responsibilities include:

* Recruit the claims examiners
* Create and maintain a culture of continuous process improvement, establish and manage team goals, encourage and embrace a transparent and collaborative work culture.
* Oversee financial management of claims and partner payments, and claims vendor operations.
* Establish tools and processes to monitor and measure quality and productivity.
* Ensure timely and accurate invoicing of clients.

Claims Processing Responsibilities

* Lead a high performing team to execute claims processing contractual responsibilities for multiple groups/payers.
* Lead the timely, accurate and efficient processing of claims.
* Collaborate with cross functional leaders to ensure all claim payment activities are executed timely, accurately, and appropriately.
* Manage claims payment schedule.


What you’ll need

* A minimum of 3 years’ experience as a Claims Manager for a Health Plan or TPA
* BA/BS degree
* Strong knowledge of medical coding (ICD-10, HCPCs/CPT, etc.)
* Extensive knowledge of all aspects of Medical Claims (both Facility and Professional)
* Excellent organizational and project management skills
* Strong communication skills
* Strong computer skills including MS Office skills


Company Culture & Values

1. Get to know our users & blow them away
2. Be candid and assume good intent
3. Experiment with new ideas, plan carefully, and execute with precision
4. Be good: only do things that would make your mother proud
5. Don’t cut corners
6. Be an owner


Working at Flume Health

At Flume Health, you’ll work alongside other self-starters solving real-world problems and streamlining the inefficiencies in the complex healthcare industry.

Investing your time with Flume means having an immediate impact on the health and lives of patients throughout the US. You’re empowered to do what’s best for everyone and trusted to make the right decisions when and where you need them.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

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