Supervisor, Claims

SUMMARY:   

The Claims Supervisor is responsible for guiding work coming into and going out of the Claims Department, which may include developing a timeline for projects and delegating components to members of the team, including him/herself. The Claims Supervisor often provides information to the Claims Manager or updates the company on the team’s progress in meetings or through regular email contact or reports.

RESPONSIBILITIES/TASKS:

• Supervise a team of Claims Specialists and others claim roles

• Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.

• Identifies and/or analyzes business problems and devise procedures for solutions to the problems.

• Develops and maintains an effective working relationship with customers.

• Effectively leads projects/teams in order to produce desired results.

• Responsible for corporate communication of project results.

• Develops and implements desk levels and policies and procedures for deviations of Advantasure standard processes.

1. Participate in the CMS audit of MA plans performance.
2. Manages daily inventory and Turnaround of claims inventory 
3. Handle and resolve escalated phone calls/issues
4. Work to resolve individual conflicts and problems with a specific project or task
5. Provide Manager with information regarding performance of members of the Claims Team
6. Work with Human Resources to coordinate interviewing, hiring, and development of new hires to department
7. Coordinate with Vendors within the Claims system
8. Coordinate with Account Managers/Eligibility/Provider Relations, etc.
9. Responsible for daily production (Individual)
10. Respond to subject matter expertise questions as needed
11. Approve and manage employee time sheets
12. Performs and holds 1:1 and Team meetings on a regular and consistent basis
13. Interacts, coaches, counsels, and trains a staff of claims examiners and supporting roles in accordance with company policies and applicable labor laws.
14. Address and document performance issues; coach or discipline employees as necessary

DIRECTION EXERCISED: 

Directly supervises non-exempt and exempt staff in accordance with company policies and applicable Federal and State Laws.  Responsibilities include but are not limited to effectively interviewing, hiring and training employees, planning, assigning and directing work, appraising performance, rewarding and counseling employees, addressing complaints and resolving problems, supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the job.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS

EDUCATION:

Bachelor’s degree in Business Administration, Computer Science, Information Technology, Health Care or other related field preferred. Relevant combination of education and experience may be considered in lieu of degree. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Five years’ experience of Advantasure Platform systems experience with demonstrated technical knowledge that provides the necessary skills, knowledge and abilities. Claims background in a Medicare Advantage Organization preferred. Two years of supervisory experience required. Previous experience of claims analyst using facets, or equivalent, for claims and enrollment systems preferred. 

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

• Knowledge of Medicare Advantage processes and Centers for Medicare & Medicaid Services (CMS) guidelines.

• Knowledge and experience of the standard Life Cycle of a Claim

• Experience in the Claim Adjudication process for medical claim processing editing, pricing and procedures

• Excellent verbal and written communication skills with an ability to disseminate information in an effective manner. Excellent interpersonal skills and ability to interact with employees at different levels