Supervisor, Claims

Position Summary

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.

Key Duties And Responsibilities

• 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.

Minimum Qualifications

• 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.

Preferred Qualifications

• Experience working in a multi-employer or Taft-Hartley environment.

Working Conditions/Physical Effort

Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times.

Pay

Compensation: $80,000/annually

Benefits

As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!