Claims Supervisor

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

📋 Description

• Oversee the daily operations of the Claims Department.

• Supervise a team of Claims Specialists and manage their daily functions.

• Ensure healthcare claims are processed in a timely, efficient, and accurate manner.

• Manage workforce distribution and staffing to maintain compliance with regulatory and contractual obligations.

• Provide training, coaching, and ongoing support to team members.

• Assess team performance to enhance productivity and quality standards.

• Address escalated claims issues and resolve complex cases effectively.

• Formulate strategies aimed at minimizing escalations.

• Collaborate with the Claims Manager to refine processes and policies based on trends in claim issues.

• Serve as a liaison and escalation contact for clients.

• Engage in client meetings to discuss service performance, resolve issues, and collect feedback.

• Prepare client reports and presentations that highlight performance metrics and initiatives.

• Optimize the use of the RAM processing platform and related products for automated and efficient manual results.

• Develop departmental policies, procedures, workflows, and handoff processes.

• Design training methodologies and onboarding schedules.

• Collaborate with IT/Ops Support on User Acceptance Testing (UAT) plans, scenarios, and cases.

• Evaluate reporting requirements and implement metrics-driven management for departmental and client outcomes.

⛳️ Requirements

• 7-10 years of experience in the healthcare industry, specifically within the payer segment of Medicare Advantage, Managed Medicaid, or a competitive environment.

• Experience in a Business Process as a Service (BPaaS) setting is advantageous.

• Background in a production environment is preferred.

• Proven ability to meet performance benchmarks.

• Strong attention to detail.

• Capability to follow documented procedures to achieve intended results.

• Proficiency in Microsoft Word and Excel.

• Excellent interpersonal skills.

• Strong written and verbal communication skills.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• 401(k) plan with matching contributions.

• Life insurance.

• Long-term disability insurance.

• 5 weeks of vacation.

• Paid holidays.