Claims Supervisor

Position Summary
The Healthcare Claims Supervisor is responsible for the overall operational performance, client satisfaction, KPI achievement, reporting oversight, and leadership of assigned healthcare claims accounts. This role oversees Team Leads and Claims Examiners while serving as a key liaison between clients and internal departments including Operations, Quality, Training, Workforce Management, and Account Management.

The Supervisor is accountable for ensuring production, quality, turnaround time, attendance, compliance, and service-level expectations are consistently achieved. This individual must be highly organized, data-driven, proactive, and capable of managing both operational execution and client relationships in a fast-paced environment.

Success in this role requires the ability to identify operational risks early, drive corrective actions, maintain strong client confidence, and foster a culture of accountability, performance, and continuous improvement.

Key Responsibilities
Operational Leadership & Accountability

• Oversee daily claims operations across assigned accounts and lines of business.
• Ensure achievement of all client KPIs, SLAs, quality standards, and operational deliverables.
• Monitor productivity, inventory, aging, turnaround times, workflow distribution, attendance, and backlog risks.
• Develop and execute action plans to address performance gaps and operational challenges.
• Partner with Workforce Management and Operations Leadership on staffing, forecasting, and capacity planning.
• Support implementations, transitions, and account expansions to ensure operational readiness.
• Successfully complete training and demonstrate proficiency in assigned claims processes.

Performance & KPI Management

• Maintain ownership of account-level operational metrics and performance outcomes.
• Analyze trends related to productivity, quality, error rates, SLA compliance, attendance, inventory aging, and client escalations.
• Hold Team Leads and staff accountable through coaching, performance reviews, corrective actions, and performance improvement plans.
• Drive a culture of urgency, accountability, and continuous improvement.
• Ensure timely resolution of performance issues and consistent execution of operational expectations.

Client Management & Client Satisfaction

• Serve as a primary operational contact for assigned client accounts.
• Participate in weekly, monthly, and quarterly business reviews, client meetings, calibrations, and operational discussions.
• Build strong client relationships through proactive communication and consistent operational performance.
• Manage client concerns and escalations with clear ownership, timely follow-through, and effective resolution.
• Collaborate with Account Management and Leadership to support client satisfaction, retention, and growth.

Reporting & Metrics Management

• Prepare, analyze, and present operational reports, dashboards, and performance metrics.
• Deliver accurate and timely reporting to clients and internal leadership.
• Identify trends, risks, and opportunities through data analysis and recommend actionable solutions.
• Utilize Excel, Power BI, client systems, and operational reporting tools to monitor account performance.
• Present performance results, improvement initiatives, and operational recommendations professionally and effectively.

Quality, Compliance & Process Improvement

• Ensure compliance with client requirements, HIPAA regulations, CMS guidelines, and company policies.
• Partner with Quality Assurance teams on calibrations, audits, error trend analysis, and remediation efforts.
• Conduct root cause analysis and implement corrective actions to improve quality and efficiency.
• Support audit readiness, compliance initiatives, and process improvement programs.

Team Leadership & Development

• Coach, mentor, and develop Team Leads and Claims Examiners.
• Support onboarding, nesting, cross-training, and ongoing employee development.
• Reinforce leadership accountability and operational excellence.
• Promote employee engagement, retention, succession planning, and professional growth.
• Foster a culture of teamwork, ownership, professionalism, and high performance.

Key Performance Indicators (KPIs)

• Production Goal Achievement
• SLA Compliance
• Quality Scores (Target: 98%-100%)
• Inventory & Aging Management
• Attendance & Adherence
• Client Satisfaction
• Escalation Resolution Timeliness
• Reporting Accuracy & Timeliness
• Reduction of Repeat Errors
• Employee Retention & Engagement
• Coaching and Performance Documentation Compliance

Qualifications

• Minimum 3-5 years of Medicare Advantage and/or MediCal healthcare claims leadership and hands on experience.
• Prior supervisory experience overseeing production teams required.
• Strong experience managing healthcare payer operations and claims workflows.
• Experience with client-facing operations and client relationship management.
• Strong reporting and data analysis experience required.
• Experience owning operational KPIs and performance deliverables.
• Strong leadership, accountability, organizational, and communication skills.
• Experience with systems such as EZ-CAP, QNXT, Facets, Jiva, Plexis, or similar preferred.
• Intermediate to advanced Excel and reporting/dashboard experience required.
• Experience managing offshore and/or remote teams preferred.

Salary $53,000-$60,000

What We Offer

• Remote work offered
• Equipment provided
• Paid training to set you up for success
• Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
• Paid Time Off (PTO)
• 7 paid holidays
• A supportive team and a company that values internal growth

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