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Claims Supervisor

he Supervisor of Claims supervises the Prominence Claims team processing commercial, ASO and Medicare claims to ensure quality service is being delivered to Health Plan members, employer groups, brokers, insurance carriers, providers and their office staff. The Claims Supervisor coaches, counsels, and trains a staff of claims analysts and supporting roles in accordance with company policies and applicable labor laws. The Supervisor is responsible for promoting quality, superior customer service, and identifying enhancements and changes to workflows to increase effectiveness and productivity. Provides on-going feedback on what is going well and areas for improvement/growth. Must be able to make independent decisions, multi-task and prioritize tasks, and with other internal departments to meet company goals.
Job Requirements:
Regulatory Requirements: • At least two years of healthcare management experience including increasing levels of responsibility. • At least two years’ experience working with health plans insurance products or employer healthcare benefits programs. • At least two years of experience in claims processing. • Associate’s degree or equivalent experience. • Knowledge of State and Federal regulations as they pertain to the health insurance industry. • Previous experience reviewing and analyzing statistical data to identify trends as well as potential problems/opportunities for improved service quality. Language Skills: • Ability to effectively communicate in English, both verbally and in writing. Skills: • Knowledge of various computer systems including all Microsoft Office systems, Outlook, and budgetary, time and attendance type software systems. • Demonstrates ability to work and problem-solve independently --- has taken initiative to research and resolve processing and system issues using available resources and without waiting for direction. Views obstacles encountered as opportunities for improvement and offers ideas and solutions. Knows how to organize people and activities • Possesses strong/broad understanding of the claims analyst process, medical/dental terminology, and claims processing procedures • Possesses superior Customer Service skills --- seeks to understand expectations of internal and external customers. Knows which questions to ask and what information to verify to get to the root cause of a problem. • Possesses excellent verbal and written communication skills --- has demonstrated the ability to effectively and professionally communicate information to both internal and external customers. This includes facilitating meetings, conducting training sessions, organizing and documenting workflows and processes, handling escalated calls, and /or responding to appeals • Results orientated – understands where tasks and assignments fall into the big picture and organizes and prioritizes accordingly. Diligently follow-ups with Director, peers, other departments, and customers.

Time:  Full time
Salary:  Salary
Category:  Operations

Updated: 2/6/2017 2:12:32 PM