Supervisor Clinical Review

Job Description

The Supervisor of Clinical Review Processing is responsible for providing leadership, support, and development to the front-line Clinical Review Processing team. This position oversees and is accountable for the day-to-day operations of Clinical Review Processing functions including but not limited to monitoring, maintaining, and maximizing team performance, overseeing inventory, ensuring service agreements are met, and delivering a quality service and product to our customers.

This person will work hybrid out of our Alpharetta, GA office.

Responsibilities

• Leads, coaches, inspires and develops Clinical Review Processing employees to meet departmental expectations and business unit goals in the processing of claims requiring clinical review. Assists team in resolving complex or escalated claim processing issues as needed.
• Develops and implements goals around individual key performance indicators (KPI's) and competencies to ensure the business unit and the Clinical Review Processing team delivers quality outcomes for our customers and clients.
• Continuously delivers performance feedback loop for direct reports. Effectively communicates team KPI status with Manager monthly and provides weekly updates and action plans as needed.
• Monitors daily workload reports and assists the Manager with Enterprise inventory. Forecasts, collaborates, and communicates workflow strategy with Enterprise counterparts, and allocates the workload and respective staff as needed to maintain efficiency, accuracy, and to meet established performance expectations.
• Provides support in the proper implementation of clinical claims processing regulatory and compliance requirements, balancing the requirements of multiple major commercial and government clients including performance guarantees. Monitors adherence to customer performance guarantees and develops and implements corrective actions as necessary.
• Provides continuous evaluation of department processes and procedures, identifying opportunities to reduce error trends and increase first pass accuracy rate. Seeks to improve performance through automation, leading to improved operational outcomes and customer experiences.
• In collaboration with the Training and Enablement teams, ensures training is delivered appropriately and assists in the development and review of materials and procedures.
• Develops and continually assesses opportunities to enhance and improve team engagement and implements best practices leading to strengthening the team foundation.
  
  

Qualifications

• 5+ years with an Associate's degree; 0+ years supervisory
• Minimum of 6 years of experience in the insurance industry with concentration in Clinical Review required. Experience building a team and creating/implementing new processes.
• 1+ years as Supervisor preferred.
• Excellent leadership skills, including the ability to set a vision, inspire team members, and develop a culture that fosters growth and collaboration
• Demonstrated ability drive to success in a fast-paced environment
• Analytical, critical thinking, and problem-solving skills. Ability to effectively diagnose situations and provide solutions
• Good organizational and time management skills with the ability to adhere to deadlines
• Ability to develop collaborative and productive working relationships at all levels of the organization
• Ability to interpret, develop and ensure adherence to enterprise and departmental policies and procedures
• Working knowledge of project management best practices
• Knowledge of clinical codes, terms and processes
  
  

Licenses

• Six Sigma Green Belt Certification. Upon Hire Pref'
  
  

Base Pay Information

The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. $59,000 - $130,900

Additional Information

Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes:

• Competitive base and incentive pay
• 401(k) with robust matching and non-matching contributions
• Rich medical & pharmacy benefits
• 100% employer-paid dental and vision benefits
• Holistic wellbeing program with deep financial incentives
• Generous paid time off plus 12 paid holidays and your birthday off
• Culture of growth and learning: career development; tuition reimbursement; recognition program
• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
• Social responsibility and volunteer opportunities
• Employee discount program
  
  

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Please note, Delta Dental will not sponsor applicants for work visas for this position.

About The Team

At Delta Dental, we're behind millions of smiles and counting. For over 68 years, we've served our communities by increasing access to affordable, quality care - but that commitment to care extends beyond the people we serve, to the dedicated employees who make those smiles genuine. We've come this far by building equitable programs that offer opportunities for advancement, create meaningful connections and improve the lives of our employees and their families. Because we know that when we take exceptional care of each other, we can make a positive impact for all.

We champion an inspirational workplace through our commitment to trust, service, excellence and innovation. Joining us means working for a company that offers stability and balance, opportunities for leadership at all levels, and a work environment focused on teamwork and camaraderie.

Discover the smiling faces behind Delta Dental and experience our values and culture in action by connecting with us on social media. Follow Delta Dental Ins. on Facebook and Instagram, on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn. If you've got an appetite for innovation and want to be a part of a team that's transforming the future of health care, join us!

Since 1955, we have offered comprehensive, high-quality oral health care benefits to millions of enrollees and built the strongest network of dental providers in the country. The Delta Dental of California network includes affiliates Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; and Delta Dental of West Virginia, providing dental benefits to more than 31 million people across 15 states, the District of Columbia, Puerto Rico and the Virgin Islands.

The company and its affiliates are part of Delta Dental Plans Association (DDPA), a not-for-profit national association based in Oak Brook, Illinois. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Collectively, we deliver benefits to more Americans than any other dental insurance company.

Delta Dental is an equal opportunity employer. We are committed to building and maintaining a diverse and inclusive workplace for all employees. Applicants will not be discriminated against because of race, color, religion, creed, national origin, ancestry, citizenship status, sex (including pregnancy), sexual orientation, gender or identity expression, age, disability, marital status, medical status, veteran status or any other status protected under federal, state, or local law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico, District of Columbia (Washington D.C.) or other US Territories at this time.

Proof of eligibility to work in the United States must be provided if selected for hire.

• Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York
  
  

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