Claims Processing Supervisor

About the role

The Claims Supervisor manages associates' assignments and work queues on a daily and weekly basis, ensuring the timely resolution of claims, accurate billing, and the effective distribution of work to support operational efficiency. This is a remote opportunity. Applicants can live anywhere within the Continental USA. Night Shift Schedule: 10:00pm to 6:30am eastern. Must be able to work eastern time zone hours.

Responsibilities

• Works in conjunction with the 3rd Party Claims Manager to establish specific associate goals, department wide goals, performance tracking and quality assessment audits.
• Establish and maintain professional and effective relationships with staff, peers, payers and other stakeholders.
• Provides associates assignments and work queues on a daily and/or weekly basis. Including resolution, billing, and appropriate distribution of work.
• Maintains quality of work performed by all associates, including interaction and compliance.
• Holds regularly scheduled meetings with staff to discuss performance metrics and ensure employees are on track to meet their goals.
• Reports to Manager any trends occurring with payers and/or processes.
• Updates staff with communications and process changes as directed by 3rd Party Claims Manager, Director or Senior Management and ensures compliance.
• Handles escalated calls from customers and payers to ensure proper resolution.
• Mentors and provides oversight of Team Leads and Associate II staff to ensure they are adequately communicating staff training needs, shadowing staff when assigned, performing monthly quality assessment reviews, and taking a lead role in any special projects that may be assigned by Supervisor or Manager.
• Manages staff attendance and time sheets for payroll (Kronos) system. Assures staff is meeting attendance policies and reports any variations to Manager.
• In conjunction with feedback provided by Team Lead and/or Associate, monitors work performance including quality. Ensures assignments are fair and balanced based on Team Lead/Associate level skills sets.
• Works to update, create and/or maintain Standard Operations Procedures for the department.
• Ensures Sarbanes Oxley (SOX) compliance on all variance, write-off and convert exception reports inclusive of adequate signatures are obtained. Proper storage of completed documents per Compliance policies.
• Performs other tasks as assigned.

Qualifications

• Education/Learning Experience: Associates degree, 4 year college, technical degree or 4+ years equivalent experience.
• Work Experience: 3+ years direct supervisory experience.
• Desired: 3rd Party Billing or collections/billing experience in the healthcare industry, AS400 computer systems experience or Pharmacy Technician.

Skills/Knowledge

• Proficiency in MS Office Products (Excel, Word).
• Basic computer knowledge.

Behavior Competencies

• Excellent communication skills, both written and oral.
• Problem solving and detail oriented.
• Strong time management, organizational skills and self-starter.
• Strong attendance and leadership.

About Our Line of Business

PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success.