PositionSummary
The Supervisor, Claims provides daily leadership and supervision to a Claims team in accordance with Company guidelines, client needs, and regulatory requirements.
"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."
KeyDutiesandResponsibilities
- Provides daily leadership and supervision to staff consistent with Company values and mission.
- Assigns, distributes, and monitors quality and quantity of work produced, ensuring employees are held accountable for consistently meeting quality and production requirements.
- Develops staff through performance management, goal setting, training, and effective employee relations.
- Maintains current knowledge of assigned Plan(s) and effectively applies knowledge; provides oversight of processing activities to ensure compliance.
- Optimizes workflows/processes, tools, and staff allocation to ensure efficient and cost-effective day to day operations.
- Troubleshoots customer/client service issues and assists in the successful implementation of new clients.
- Reviews and interprets new benefits plans or changes/updates to existing plans; tests benefits for validation and accuracy. Develops and distributes resource documents as needed.
- Based on location needs, may provide advanced technical review and support of claims processing.
- Provide technical review of all types of claims including large dollar and complex claims to validate benefit allowance and category.
- Investigate, evaluate, and report on advanced cases for third-party recovery including stop-loss, accident, medical malpractice, subrogation, and Worker's Compensation.
- Compiles documents, records, and data for external audits, as requested.
- Assists in the development and documentation of departmental SOP's.
- Performs other duties as assigned.
MinimumQualifications
- High school diploma or GED.
- Four years of experience processing complex health and welfare claims in a third-party administrator.
- One year of experience in a lead or supervisory role.
- Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes.
- Thorough knowledge of claims operations to include payment of claims, interpretation of contracts, communication of benefits, etc.
- Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly.
- Highly developed sense of integrity and commitment to customer satisfaction.
- Ability to communicate clearly and professionally, both verbally and in writing.
- Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities.
- Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment.
- Computer proficiency including Microsoft Office tools and applications.
PreferredQualifications
- Experience working in a multi-employer or Taft-Hartley environment.
*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.
WorkingConditions/PhysicalEffort
- Prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift up to 15 pounds at times.
Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location.
Compensation: $82,500/annually
