Supervisor, Provider Pricing Unit

About the role

Health Plans, Inc. (HPI) is a New England-based Third-Party Administrator (TPA) of self-funded health and benefit plans. HPI was founded in 1981 to provide comprehensive health plan administration to employers, municipalities and Taft-Hartley plans. Health Plans has grown to become an industry-leading TPA by offering customized self-funded benefit plans to employers, combined with superior customer service and investment in the latest administrative and data-mining technology, and reinsurance (stop-loss) security.

The Provider Pricing Supervisor oversees a dedicated unit of Provider Pricing Specialists. This role is responsible for overseeing daily team operations, planning for future workflow and scheduling. The Supervisor also trains, mentors and continues development of staff to better coordinate the daily production, turnaround time and work quality of Provider and Pricing processing while meeting company goals. Additionally, the Supervisor establishes and regularly reviews policies and procedures with the team to ensure compliance. By leading with integrity and setting a strong example, the Supervisor sets clear expectations and promotes a collaborative and results-driven environment.

Responsibilities

• Daily monitoring of inventory levels with daily work plan to meet expected turnaround times
• Notify department Management of turnaround time issues and offer action plan to resolve
• Daily oversight of referral and precertification process to ensure timely and accurate processing
• Responsible for review and maintenance of department policies and procedures
• Partner with department Management to identify team inefficiencies and solutions
• In conjunction with department Management, provide daily oversight and direction to staff within the Provider Pricing team
• Develop appropriate performance action plans to ensure production and quality measures are achieved by each team member
• Participate in interviewing and selection of qualified candidates for the team
• Monitor employee performance; provide timely feedback with goals for improvement and write and/or deliver annual reviews
• Oversee training plan for all new hires
• Advise department Management of issues raised by staff; suggest actions to improve processing or resolve issues
• Work with appropriate subject matter experts to provide ongoing training and development within the team
• Manage relationships with internal and external business associates
• Special projects as assigned

Qualifications

• High School diploma or equivalent education
• Working knowledge and experience with web-based Claim Adjudication system
• Ability to provide leadership
• Ability to coordinate with management as effectively as with all subordinates
• Ability to multitask efficiently and accurately
• Ability to prioritize and multitask effectively as a leader
• Communicates effectively, both verbally and in writing
• Ability to work both independently and as a member of the management team
• Ability to anticipate and understand systems interactions
• Must be detailed, analytical and accurate
• Recognize the need for follow-thru and follow-up
• Ability to work within specified timeframes and meet deadlines
• Recognize and maintain confidentiality of work materials as appropriate

Preferred qualifications

• Associate or bachelor's degree
• Prior Supervisory experience
• Three to five years of TPA and Medical Operations claim experience
• Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint

Benefits

• Medical, Dental and Vision and Prescription Drug Coverage
• Fitness Reimbursement Benefit
• Employee Assistance Program
• Flexible Spending Account & Health Savings Account
• 401(k) and Bonuses
• Generous Paid-Time Off & Volunteering Opportunities
• Educational Assistance & Professional Development Opportunities