Claims Supervisor

: Claims Supervisor Position Summary: This position will be responsible for providing direction and leadership to a team of employees as it relates to third party claims administration and related processes. Also, ensuring effective management of this staff produces results indicative of a high performing team. Responsibilities include managing day-to-day claim operations including scheduling of resources, monitoring of performance and workflows. Position Responsibilities:

• Perform supervisory activities including hiring, training, performance reviews, and performance improvement plans.
• Develop and implement staff coaching program with goal to motivate and build knowledge for a career path.
• Supervise daily claim processing administration and related functions according to established policies and procedures and applicable legal and regulatory guidelines.
• Distributes work through review of inventory and pended claim reports.
• Provide claims support to teams in reviewing, resolving, member and provider appeals and disputes.
• Responsible to process and respond to Health Plan inquiries and coordinates with appropriate departments for any provider, member, or system issues.
• Responsible for recommending changes in guidelines, procedures, and policies. Ensuring the use of standard methodology workflows and operational excellence.
• Develop strategy and plans to ensure completion of operational goals and objectives are met/maintained.
• Identify training needs and drive strategy for delivery to staff as part of continuing education model.
• Effectively utilize staff resources to meet departmental goals in accordance with business initiatives and performance measures.
• Establish and manage performance expectations in the areas of quality, production, and core competencies according to defined organizational and department protocols.
• Establish appropriate support to backup all department tasks, and most importantly, critical functions as defined by the task or the leadership team.
• Plan and organize work assignments for distribution and re-distribution, as necessary to provide prompt and accurate service, ensuring turnaround goals are met/exceeded.
• Define and manage staff level goals to meet client and department expectations.
• Define and manage appropriate controls to validate work process is being followed.

• Identify and implement process improvement and automation opportunities including but not limited to new techniques/processes, reports, or procedures for continuous refinements.
• Lead department level meetings, driving agenda items and specific department initiatives to ensure employee engagement.
• Coordinate and remediate the resolution of claim issues, within the defined performance turnaround goals. Evaluate the need for escalation and facilitate to allow prompt resolution.
• Perform other duties as assigned.

Please note this is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Position Qualifications:

• 4-year degree or equivalent combination of education and work experience required.

• Minimum of two years' experience in Third Party Administration (TPA)

• Computer literacy and familiarity with MS office
• Excellent oral and written communication skills

• Exceptional customer service, and interpersonal skills
• Effective problem-solving and influencing skills
• Strong organizational, self-motivation, and decision-making skills
• Ability to manage multiple priorities in a fast-paced environment
• Ability to work independently and collaboratively, as needed
• Excellent time management and organizational skills

• Service orientation
• Integrity
• Ethical practice and confidentiality