The Claims Supervisor is responsible for providing coaching, mentoring, and training a staff of Claims Examiners while promoting quality and superior customer service. The Claims Supervisor is accountable for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.
Primary Responsibilities: • Provide full-time technical support to Claims, internal departments, vendors, and customers. • Distribute daily work to the team and monitor aging inventory resolution. • Train new hires, vendors, and existing staff as needed. • Research and respond to escalated issues and pertinent information on claims requiring adjudication. • Review and process High Dollar claims and conduct quality reviews of claims and logic changes/updates. • Assist Customer Service in resolving customer questions and concerns. • Analyze, assign, and maintain claim inventory projects. • Researching and resolving client inquiries and performing client-requested claim adjustments. • Coach, counsel, and mentor employees to meet quality, claims accuracy, and productivity standards, and address performance and disciplinary issues. • Manage payroll, timesheets, employee schedules, and time off requests. • Consistently host individual and team meetings with team members.
Essential Qualifications: • Experience in supervisory or leadership role preferred. • Advanced knowledge of Excel. • Strong knowledge of contracts, medical terminology, and claims processing and procedures. • Advanced claims adjudication experience, including facility, professional, and ancillary claims. • Excellent written and oral communication, interpersonal, and negotiation skills with the ability to prioritize tasks. • General knowledge of medical terminology, medical specialties, and HIPAA Confidentiality laws. • Problem-solving and organizational skills, ability to prioritize and multitask effectively. • Ability to establish and maintain positive work relationships with clients, coworkers, members, providers, and customers. • Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
Annual Salary Range: $60,000 - $80,000
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Hospitals and Health Care
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