Claims Customer Service Supervisor

Position Duties & Responsibilities

• Provide management support in reviewing, researching, scanning, archiving, statusing, and verifying eligibility of claims.
• Oversee the preparation of medical records for scanning and routing to appropriate departments.
• Analyze data, identify trends and design/provide reports as necessary.
• Communicate, collaborate and research claims inquiries or issues as they arise, applying appropriate knowledge and experience.
• Apply knowledge of applicable laws, regulations and compliance requirements to ensure that claims are processed properly according to HIPAA, state specific regulations and grievance procedures.
• Use appropriate documentation, reference materials and/or websites to ensure that claims are processed accurately and efficiently.
• Monitor inbound provider calls to ensure accurate information is shared in a timely and professional manner.
• Respectfully and supportively collaborate with business partners to help address issues related to the Claims Customer Service area.
• Identify, develop and implement new processes procedures and solutions as needed.
• Identify and communicate opportunities to improve claims processing efficiency and reduce rework.
• Track, trend, and communicate claim errors with leadership along with training recommendations.
• Supervise, monitor, track and direct day to day operations staff.
• Oversee annual internal reviews and audits of claims operations as part of an ongoing quality control process.
• Develops staff through performance management, goal setting, training, and effective employee relations and retention efforts.
• Ensure that departmental standards and timelines are met within each unit.
• Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
• Supervise daily activities of claim examiners, workflow, production, pended claims, and audits.
• Makes recommendations for process improvement as needs are identified.
• Perform other duties as assigned.

Education, Training And Experience

• Minimum of 5 years Supervisory experience in Manage Care Claims.
• Minimum of 5 years’ experience with health care claims adjudication.
• Knowledge of claims life cycle, medical terminology, ICD-9, CPT, HCPCS, HCFA1500, UB92’s, RBRVS, RVS and Coordination of Benefits (COB).
• Thorough understanding of claims operations to include payment of claims, interpretation of contracts; communication of benefits and eligibility.
• Ability to draw upon knowledge and experience to anticipate issues, potential risks, implications, and changes to Medicare.
• Strong math and analytical skills, including the ability to analyze and organize data.
• Excellent ability to build and maintain business relationships with providers by providing prompt and accurate service.
• Strong attention to detail.
• Proficiency in Microsoft Office products, including Power Point, Word, and Excel.
• Proven ability to lead team members in a positive and productive manner.
• Demonstrated strong organizational, analytical, oral presentation, written communications, decision-making skills and leadership skills.
• Must be able to work under general guidance of Claims Manager with little direct supervision.