Supervisor, Claims Shared Services

Job Description

Job Description

Position Summary:

As the Claims Shared Services Supervisor, you will oversee the daily operations of the mailroom and supervise a team of medical Claims Analysts and the Claims Training and Quality Analyst. Your primary responsibility is to ensure efficient and accurate processing of incoming mail and medical claims, adhering to regulatory requirements and organizational policies. You will lead and develop your team, monitor productivity and quality metrics, and collaborate with other departments to optimize workflow and customer service.

Essential Duties and Responsibilities:

1. Manage and lead mailroom staff, Claim Training and Quality Analyst, and Claims Analysts, providing guidance, training, and performance feedback.
2. Ensure timely and accurate processing of incoming mail, including sorting, distribution, and documentation.
3. Handle escalated claims issues and discrepancies, resolving them promptly and effectively.
4. Conduct regular audits and reviews to monitor compliance with regulatory requirements and organizational standards.
5. Develop and implement efficient workflows and procedures to enhance productivity and reduce turnaround times for mailroom operations and claim Analysts audits and process.
6. Collaborate with IT and other departments to streamline processes and implement technological solutions where applicable.
7. Provide training, coaching, and ongoing support to mailroom and claims analysts, Claims Examiner III ensuring they have the necessary skills and knowledge to perform their roles effectively.
8. Foster a culture of continuous improvement and professional development within the team.
9. Prepare and analyze reports on mailroom and claims processing metrics, identifying trends, areas for improvement, and opportunities for efficiency gains.
10. Present findings and recommendations to management to support decision-making and strategic initiatives.
11. Oversee Claim testing, conducted by the Claim Examiner III.
12. Monitors and analyses productivity statistics to provide timely feedback to the employee through performance evaluation, recognition, and coaching opportunities.
13. Advises Claims Director of developing trends and areas of concern based on daily operations.
14. Handles paid time off requests to ensure sufficient coverage for planned and unplanned absences and updates timesheets accordingly.
15. Responds to daily inquiries, concerns and feedback received in the Analyst distribution list.
16. Monitors the daily functions of all in-coming and out-going mail processes.
17. Maintains compliance with regulatory requirements and contractual term.
18. Demonstrates knowledge and understanding of all systems, product lines benefit levels.
19. Requests and tracks claim payment refunds to ensure recoupment of overpayments.
20. Adjudicates and enters claims when necessary.
21. Facilitates pre-payment audit reporting and payment posting process.
22. Identifies inappropriate or questionable claims and refers to Claims Manager, SUI, or CMO for review.
23. Assists with testing of benefit design, contracts, and all claims related system updates and upgrades.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications:

• Associate or Batchelor’s degree (preferred)
• 3 years of experience in a supervisory or team lead role and healthcare claims administration.
• Strong knowledge of medical billing codes (e.g., CPT, ICD-10) and insurance claim processing guidelines.

Skills and Abilities:

• Ability to recognize and analyze the implications of new situations and develop workable solutions.
• Familiarity with healthcare regulations (e.g., HIPAA) and compliance requirements.
• Excellent leadership, communication, and interpersonal skills.
• Analytical mindset with the ability to problem-solve and make data-driven decisions.
• Experience with claims processing software (e.g., Epic,) and mailroom automation tools.
• Understanding of managed care contracts and reimbursement methodologies.
• Possess strong verbal and written communication skills.
• Proficient demonstration skills for departmental and corporate audiences.
• Ability to promote teamwork and cooperation.
• Maintain positive rapport and cooperative working relationships with internal and external customers.
• Ability to provide insight and process improvement suggestions to enhance department efficiency.
• Demonstrates the ability to make decisions, take appropriate action, and follow tasks through to completion.

Work Schedule:

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

Background Screening Notice:
In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.

Additional information is available at:
???? h