Claims Operations Supervisor

Claims Operations Supervisor
Contract to Perm Position
Hybrid - 3x per week in Philadelphia, PA

The Claims Operations Supervisor is responsible for the day-to-day operational oversight, performance management, and quality assurance of an offshore claims processing vendor supporting Independence's Claims Processing operations. This role ensures that all vendor-managed functions are completed promptly, accurately, professionally, and in compliance with contractual, regulatory, and departmental requirements.

The Supervisor serves as the primary operational liaison between Independence and the offshore vendors, providing direction, guidance, issue escalation, and continuous improvement oversight to ensure service levels and customer experience expectations are consistently met.

Responsibilities:

• Provides operational oversight and governance of offshore vendor claims processing activities.
• Ensures vendor compliance with contractual service level agreements (SLAs), key performance indicators (KPIs), quality standards, and regulatory requirements.
• Monitors daily, weekly, and monthly vendor performance metrics including productivity, accuracy, turnaround time, and quality results.
• Evaluates operational effectiveness and efficiency of vendor-managed workflows and partners with the vendor to reallocate resources or adjust processes as needed.
• Serves as the primary point of contact for operational issues, escalations, and resolution of vendor-related concerns.
• Collaborates with internal stakeholders (Claims Operations, Quality, Compliance, IT, Finance, and Vendor Management) to coordinate vendor activities and resolve issues.
• Communicates, interprets, and enforces corporate and departmental policies, procedures, and process changes with the offshore vendor.
• Leads root cause analysis for errors, defects, or service failures and ensures corrective action plans are implemented and sustained.
• Supports implementation of new initiatives, system enhancements, and process changes involving the offshore vendor.
• Reviews and validates vendor training plans to ensure staff are properly trained on claims processing, systems, and Independence requirements.
• Provides ongoing feedback and coaching to vendor leadership to drive performance improvement and service excellence.
• Ensures all inquiries, follow-ups, and escalations handled by the vendor are resolved in a professional, accurate, prompt, and courteous manner.
• Compiles, analyzes, and prepares operational reports related to vendor performance, trends, risks, and improvement opportunities.
• Maintains department standards to ensure an optimal customer and provider experience.
• Ensures systems, tools, and support processes required for vendor operations are functioning effectively.
• Encourages a culture of accountability, continuous improvement, and partnership with the offshore vendor.
• Performs all other appropriate responsibilities and duties as assigned.

Qualifications:

• Minimum of five (5) years of related insurance operations experience, with demonstrated experience in claims processing.
• Prior experience overseeing or working with offshore or third-party vendors strongly preferred.
• Demonstrated ability to handle sensitive operational, quality, and performance issues with tact, diplomacy, and professionalism.
• Strong vendor management and relationship management skills with the ability to influence without direct authority.
• Proven ability to analyze performance data, identify trends, and implement corrective actions.
• Excellent organizational, planning, and time management skills in a fast-paced, high-volume environment.
• Ability to prioritize work and adapt to frequently changing operational demands.
• Strong oral and written communication skills, including the ability to clearly convey expectations, feedback, and performance results to vendor partners.
• Ability to work independently with minimal guidance while maintaining accountability for outcomes.
• Experience in high-volume claims processing operations strongly preferred.
• Knowledge of Claims processing both local and BlueCard business, processes, and applications preferred.
• HealthRules experience preferred.