Claims Supervisor

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

📋 Description

• Lead a team of Claims Processors.

• Ensure precise and efficient processing of claims for employer-sponsored health plans.

• Establish productivity benchmarks and uphold quality standards.

• Promote continuous improvement initiatives.

• Collaborate with support teams to handle backlog and optimize turnaround times.

• Partner with Quality/Training and System Configuration teams to standardize processes and address issues.

• Supervise appeals, subrogation, and overpayment/refunds as necessary.

• Guarantee claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations.

• Manage claims inventory in line with standard service level agreements.

• Educate and mentor claims staff.

• Develop performance plans and offer coaching and mentoring.

• Report on claim inventory, production metrics, turnaround delays, and quality metrics to department leaders.

• Create and monitor policies and procedures for benefit plan and claims administration.

• Influence departmental morale, encourage teamwork, and engage the team in finding solutions.

• Set annual staff goals and provide performance feedback.

• Act as claims liaison for projects, initiatives, testing, system implementations, and upgrades.

• Execute other essential duties.

⛳️ Requirements

• Comprehensive understanding of insurance policies, claims handling processes, and legal requirements related to claims.

• Exceptional leadership and team management abilities.

• Capacity to analyze claims data and make well-informed decisions.

• Prior experience in claims processing or a related field, including supervisory roles.

• Knowledge of health insurance benefit administration within a self-funded context.

• Ability to read and comprehend various forms, documentation, files, and information.

• Minimum of 3 years of experience with self-funded healthcare plans and processing in a TPA environment.

• At least 3 years of experience supervising a claims team.

• Previous experience with a highly automated and integrated claims adjudication system.

• Familiarity with HealthRules Payer.

• Candidates must have authorization to work in the United States for any employer.

• Centivo does not provide sponsorship for work authorization visas.

🏝️ Benefits

• Equity.

• Bonus.

• Opportunity to work from home.

• Remote work option for candidates outside the Buffalo area.