Claims Supervisor

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Manage the daily operations of the designated claims area.

• Offer technical guidance and leadership support to staff in resolving intricate issues.

• Create and enforce policies and procedures that align with state and federal regulations.

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

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

• Ensure the claims inventory is handled accurately, promptly, and in adherence to internal and regulatory standards.

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

• Identify areas for improvement and address operational gaps and challenges.

• Review, investigate, adjust, and resolve outstanding claims, particularly those that are complex.

• Act as a point of escalation for claims-related issues.

• Oversee claims quality evaluations, document findings, and identify trends and underlying systemic issues.

• Research problems, gather background information and documentation, and address issues for the team, planning, and other departments.

• Prepare reports, analyses, and insights in accordance with established standards to drive operational excellence.

• Maintain accurate records, files, and documentation.

• Undertake designated special projects.

• Facilitate changes to accommodate current and future business requirements.

• Carry out additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• An associate degree in a relevant field or equivalent experience is required.

• A minimum of 2 years of experience in the health insurance sector, claims processing, a physician’s office, or other office services is mandatory.

• Prior experience in a supervisory or leadership role with measurable outcomes is required.

• Experience with Medicaid, Marketplace, and/or Medicare is preferred.

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

• Sponsorship is not available for employment-based visa types including H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off along with holidays.

• Flexible working arrangements including remote, hybrid, field, or office schedules.