Healthcare Claims Supervisor

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

📋 Description

• Oversee the daily operations of a medical claims processing team, including the review, analysis, and adjudication of professional, facility, and complex claims.

• Manage the distribution of workloads, ensure adequate staffing coverage, set productivity expectations, and monitor performance.

• Provide coaching, mentoring, and training to staff on claims regulations, system updates, policy changes, and adjudication processes.

• Perform quality assessments, detect error patterns, and initiate process enhancements.

• Act as a subject matter expert for escalated issues, benefit clarifications, complex claims, and policy inquiries.

• Ensure appropriate claim documentation, uniform policy application, and maintain audit-ready records.

• Collaborate with teams in Medical Policy, Utilization Management, Finance, Provider Services, and Compliance.

• Monitor metrics and generate reports related to productivity, quality, timeliness, inventory aging, and issue trends.

• Assist in testing and validating system updates, benefit changes, policy modifications, and workflows.

• Participate in recruitment, onboarding, performance assessments, and staff development initiatives.

• Ensure adherence to HIPAA regulations and confidentiality requirements of the program.

• Engage in operational redesign and continuous improvement projects.

• Support the World Trade Center Health Program, a limited federal healthcare initiative managed by NIOSH/CDC/HHS.

⛳️ Requirements

• A minimum of 5 years of experience in medical claims processing within a payer, TPA, or government healthcare setting.

• At least 2 years of experience in a lead, senior, or supervisory role within claims operations.

• Strong grasp of claims adjudication, reimbursement methods, and regulatory standards.

• Familiarity with professional and facility claim formats, including modifiers, bill types, and industry-standard adjudication practices.

• Competence in claims processing systems; experience with Plexis is advantageous.

• Excellent analytical abilities to interpret claims data, uncover root causes, and address complex issues.

• Outstanding communication skills for effectively coaching staff and collaborating with operational teams.

• Exceptional attention to detail along with a commitment to accuracy and compliance.

• Capability to work independently and successfully lead a remote or distributed team.

• US citizenship is not a mandatory requirement.

• MBI (T2) public trust requirement must be fulfilled.

• Must be able to complete the employer's identity verification process and appear on camera for virtual interviews.

🏝️ Benefits

• Comprehensive medical plan options, including choices with Health Savings Accounts.

• Dental insurance options available.

• Vision insurance plans offered.

• 401(k) plan featuring pre-tax and post-tax contributions along with company matching.

• Flexible work weeks where applicable.

• Paid time off that includes vacation, sick leave, personal time, holidays, parental leave, military leave, bereavement leave, and jury duty leave.

• Typically 15 days of paid leave granted per calendar year.

• 10 paid holidays each year.

• Eligible employees may receive up to 160 hours of paid family leave in a rolling 12-month period.

• Short- and long-term disability insurance benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance provided.

• Personal accident insurance available.

• Coverage for critical illness insurance.

• Business travel and accident insurance included.

• AI-driven career tool that identifies career progression and learning opportunities.

• Internal mobility team dedicated to supporting career aspirations.

• Comprehensive benefits and wellness packages.

• Remote work or telecommuting options available.

• Identity verification and security protocols in place.