Claims Supervisor

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Supervise the daily operations within the designated claims area

• Offer technical expertise and leadership support to team members in resolving intricate issues

• Formulate and implement policies and procedures that adhere to state and federal regulations

• Enhance processes and manage costs to ensure accurate and timely medical claims processing

• Act as a liaison among internal customers, vendors, and other stakeholders involved in the claims lifecycle

• Ensure accurate and timely management of the claims inventory while adhering to compliance requirements

• Prioritize daily workloads through reporting, load balancing, and effective management of operational overtime costs

• Identify opportunities for improvement and address operational gaps and challenges

• Assist in the review, investigation, adjustment, and resolution of pending claims, particularly complex ones

• Serve as the escalation point for intricate claims issues

• Conduct claims quality reviews, document findings, and identify trends and root causes

• Research, gather background information and documentation, and resolve issues for the team, plan, and other departments

• Prepare reports, analyses, and insights to promote operational excellence

• Maintain accurate records, files, and documentation

• Undertake special projects and other assigned responsibilities

• Drive change initiatives to support current and future business requirements

⛳️ Requirements

• Associate degree in a relevant field or equivalent experience is essential

• Minimum of 2 years’ experience in the health insurance industry, claims processing, physician’s office, or related office services is required

• Prior experience in a supervisory or leadership role with defined outcomes is necessary

• Familiarity with Medicaid, Marketplace, and/or Medicare is preferred

• Must adhere to all policies and standards

• Qualified candidates with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

🏝️ Benefits

• Competitive salary

• Health insurance coverage

• 401K retirement plan

• Stock purchase options

• Tuition reimbursement opportunities

• Paid time off in addition to holidays

• Flexible work arrangements including remote, hybrid, field, or office schedules

• Additional incentives may be included in the overall compensation package

• Equal opportunity employer dedicated to promoting diversity