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Operations Supervisor - Claims - 042778
The Operations Supervisor will play a key role in the claims department with responsibilities in both employee supervision and operational duties with some high visibility projects added to their plate. It's a role for someone who thrives in a dynamic environment and can align with our culture of "coaching to excellence".
To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by serving as a liaison between the Operations staff and Director of Operations, the Operations Supervisor position requires great attention to detail, awareness of industry trends, focus on personnel and effectiveness of the department’s ability to deliver superior results. They are constantly reducing any negative impact by identifying and correcting avoidable errors and making sure that the delivery of task is timely.
Reviewing and submitting corrections on job descriptions to make sure that the descriptions are aligned with the expectations for the role intended; screens potential candidate; conduct interviews for new associates.
Monitor and analyze department quality and productivity; Identify trends and areas of improvement; establish goals and expectations.
Conduct performance evaluations; manage disciplinary actions
Lead team to achieve common goals; acquire information to enhance and assist team in excelling; manage administrative tasks for associates
Attend meetings to obtain knowledge on upcoming events and how they will impact the Operations department as well as assess effectiveness of strategies implemented.
Develop and maintain excellent communication with other impacting departments in order to align goals, expectations and resolutions.
Perform all aspects of human resources including performance management for team, selection assessment, development, feedback, timekeeping, probationary/yearly evaluations, recognition and disciplinary actions.
Continuously improve upon staff education, communication/support while maintaining a positive work environment for associates.
Promote departmental participation to assure the operational departments are satisfied as measured by the Gallup Survey results
Supervisor has advanced knowledge of Federal, State, CMS guidelines, statutes, and regulations as they pertain to line of business.
Ensures that department policy and procedures for existing and new lines of business are active and that all desktop processes exist and are current for all lines of business.
Collaborate with internal and external customers in order to identify trends address department needs and assist with information that may be needed in order to meet organization needs.
Handle escalated phone calls with members, providers and vendors and provide resolution to difficult tasks and issues.
Review daily inventory and staffing levels and makes assignments accordingly.
Monitor, aged cases, trends to ensure adequate staffing and resources are available to ensure performance goals are met and maintained
Fiscal responsibility includes constantly reviewing and identifying if the department processes are aligned with the business needs; monitoring associate work ethics, time use and educating the staff on attendance policies to maintain fiscal awareness.
Bachelor degree preferred or a minimum of seven (7) years’ experience in Health Care.
Strong knowledge of Federal, State, CMS guidelines, statutes, and regulations as they pertain to Health Insurance
Demonstrates excellent written and verbal communications skills
Strong interpersonal relationship skills
Demonstrates ability to manage people, task and make decisions
Advanced knowledge of medical benefits, medical and dental terminology
Advanced knowledge of health care financing and health care delivery of various products including, but not limited to indemnity plans, HMO, POS and Medicare.
Advanced knowledge of Medicare eligibility, coverage and payment provisions.
Advance Microsoft Office skills including; Microsoft Word, Excel, and AMISYS claims software
Organization: HF Administrative Plan Inc
Primary Location: United States-Florida - Brevard County-Rockledge
Shift Times : 8:00 am - 4:30 pm
Job Level: Supervisor
Time: Full time
Updated: 7/3/2019 10:10:54 AM