Healthcare Claims Operations Supervisor

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

📋 Description

• Oversee daily operations related to claims for assigned accounts and business lines.

• Ensure the attainment of client KPIs, SLAs, quality benchmarks, and operational deliverables.

• Monitor productivity metrics, inventory levels, aging processes, turnaround times, workflow distribution, attendance, and backlog risks.

• Develop and implement action plans to tackle performance deficiencies and operational obstacles.

• Collaborate with Workforce Management and Operations Leadership on staffing needs, forecasting, and capacity planning.

• Assist with implementations, transitions, and account expansions.

• Maintain responsibility for account-level operational metrics and performance results.

• Analyze operational trends and propose actionable recommendations.

• Hold Team Leads and staff accountable through coaching, performance evaluations, corrective measures, and performance improvement strategies.

• Act as the primary operational liaison for assigned client accounts.

• Engage in business reviews, client meetings, calibrations, and operational discussions.

• Manage client issues and escalations through prompt resolutions.

• Prepare, analyze, and present operational reports, dashboards, and performance metrics.

• Provide accurate and timely reporting to clients and internal leadership.

• Ensure adherence to client requirements, HIPAA regulations, CMS guidelines, and company policies.

• Collaborate with Quality Assurance on calibrations, audits, error trend analyses, and remediation efforts.

• Conduct root cause analyses and implement corrective measures.

• Coach, mentor, and support the development of Team Leads and Claims Examiners.

• Assist with onboarding, nesting, cross-training, and continuous employee development.

• Foster engagement, retention, succession planning, and professional growth.

⛳️ Requirements

• At least 3–5 years of leadership experience in healthcare claims.

• Previous supervisory experience managing production teams is required.

• Strong background in managing healthcare payer operations and claims workflows.

• Experience with client-facing operations and managing client relationships.

• Proficient in reporting and data analysis.

• Experience in owning operational KPIs and achieving performance deliverables.

• Strong leadership qualities, accountability, organizational skills, and effective communication abilities.

• Intermediate to advanced proficiency in Excel and reporting/dashboard tools is required.

• Familiarity with systems such as EZ-CAP, QNXT, Facets, Jiva, Plexis, or similar is preferred.

• Experience managing offshore and/or remote teams is preferred.

• Successful completion of training and demonstrated proficiency in related claims processes.

• Knowledge of HIPAA regulations, CMS guidelines, and company policies.

🏝️ Benefits

• Remote work opportunities available.

• Equipment will be provided.

• Paid training designed to ensure your success.

• Comprehensive benefits package including Medical, Dental, Vision, Life, HSA, and 401(k).

• Paid Time Off (PTO).

• 7 paid holidays.

• A supportive team culture and a company that prioritizes internal growth.