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Supervisor, Claims Operations

Remote:

Full Remote

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

High School Diploma required, 3 years of medical claims analysis experience, Strong analytical skills, Computer systems knowledge preferred.

Key responsabilities:

Monitor daily work in the Claims department
Train and develop new and existing staff

Allied Benefit Systems, LLC Unicorn https://www.alliedbenefit.com/

501 - 1000 Employees

See all jobs

Job description

Position Summary

The Supervisor, Claim Operations will help the Management team monitor the daily work within the Claims department. The Supervisor, Claim Operations, is responsible for the training and development of new hires and existing department staff. The Supervisor, Claim Operations will plan and maintain workflows, procedures and policies that enable and encourage the optimum performance of the team.

Essential Functions

Lead employees to meet Allied’s expectations for productivity, quality, and goal accomplishment.
Assist with the development and implementation of detailed workflows to improve the consistency and accuracy of the staff
Adhere to and apply all applicable privacy and security laws, including HIPAA, HITECH and any regulations promulgated thereto
Assist other departments on questions related to the payment of claims.
Monitor all reports including the Workflow Manager, Pended Claims, Suspended Claims, Inventory Listings, Audits and Automation to ensure that all workflows are followed
Attend continuing education classes as required, including HIPAA training
Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent
The participation in continuing education in all areas affecting group health and welfare plans is required
Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed
Actively engage, coach, counsel and provide timely, and constructive performance feedback
Performs other related duties as assigned.

EDUCATION

High School Diploma with equivalent work experience required with college or advanced degrees preferred

Experience And Skills

Minimum of 3 years of medical claims analysis and adjudication experience (including dental and vision claims analysis) and demonstrated leadership potential
Strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology required
Prior experience in management and training is preferred but not required

COMPETENCIES

Accountability
Communication
Action Oriented
Timely Decision Making
Building Relationships/Shaping Culture
Customer Focus

WORK ENVIRONMENT

Remote

PHYSICAL DEMANDS

This is a standard desk role – extended periods of sitting and working on a computer are required

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.