Claims Supervisor

• Liaises between claims staff and stakeholders, including providers, members, and internal Health staff.
• Participates in claims related workgroups designed to address claims issues and improve processes.
• Prepares routine reports for the manager on productivity, error rates, complaint rates, financial recordkeeping, and other activities.
• Identifies system processing issues and assist with the root cause analysis process.
• Develops, implements, and maintains claims operation policies, procedures and workflow.
• Assists with the planning, development, and training of claims operations staff.
• Provides input related to the development and performance of employees to Manager.
• Manages daily inventory queues and assigns resources to ensure inventory is processed timely and accurately.
• Monitors daily inventory and assigned claims queues for production and issue identification.
• Generates claims operations dashboard and reports related to inventory and productivity.
• Participates in special projects as needed.
• Other duties as assigned.

Requirements

• High School Diploma and minimum 7 years of claims operations experience in a healthcare field required; or 
• Associate’s degree and minimum 5 years of claims operations experience in a healthcare field; or
• Bachelor’s degree and minimum 3 years of claims operations experience in a healthcare field.
• Minimum 3-5 years of claims operations experience in a healthcare field required
• Minimum 1 year of claims supervisory-related experience highly preferred
• Knowledge of claims payment methodologies and policies.
• Proficient in reporting applications, such as Excel, Access or SQL preferred.