Oversight Specialist

Pay range: $23 – $30 hourly

Employment type: Full-Time

Location: In-Office (Costa Mesa, CA)

Department: Claims Resolution

Job Purpose

Ensuring timely and accurate claim follow-up, denial resolution, and appeal submission while monitoring BPO agents performance through daily guidance, quality reviews, and training. Ensure claim activity meets payer requirements and contributes to overall department efficiency.

Responsibilities

• If needed, maximize productivity while performing timely claim follow-up via phone and portals, resolving denials, statusing claims, and drafting appeals.
• Monitor and support BPO agents handling claim statusing and denial resolution, providing daily guidance, productivity monitoring, and alignment with departmental standards.
• Handle high-level escalations for BPO agents.
• Audit BPO claim work for accuracy, completeness, and compliance, identifying training gaps or errors for corrective action.
• Provide training for new hires and lead refresher sessions as needed, supporting BPO development through material and coaching.
• Track BPO KPIs and report underperformance to the Director and Lead to assist in action plans.
• Ensure documentation of all claim-related actions in Jira and CollaborateMD, including updates, payer responses, reimbursement, and escalation notes.
• Maintain up-to-date knowledge of payer requirements, authorization rules, and communication standards to ensure accurate claims processing.
• Engage in team and interdepartmental meetings to troubleshoot issues, identify denial trends, and recommend process improvements.
• Communicate department needs and performance concerns to the Director and lead while supporting accountability and development.
• Participate in the department's L10 meetings, identify and bring issues, and develop and execute To-Dos and quarterly rocks to drive alignment and improvements toward Cipher VTO.
• Perform other related duties as assigned.

Minimum Qualifications

• High School Diploma or equivalent.
• 2 years' professional experience.
• 1 year minimum of management and/or healthcare experience.
• EOS knowledge/understanding — preferred.
• Proficient in Atlassian products (Jira & Confluence) — preferred.