Claims Supervisor

Position Overview

The Claims Supervisor is responsible for the daily oversight of Medicare claims processes including but not limited to the inquiry and resolution process, adjudication process, user acceptance testing and quality assurance, training, and reporting. In addition, the position assists the Claims Manager with claims related queue management (i.e., claims, inquiries, refunds, adjudications) to ensure that inventory is processed accurately and in a timely manner. The Claims Supervisor will also provide daily management and oversite of the Claims Operation staff.

Scope of Role & Responsibilities

• Liaises between claims staff and stakeholders, including providers, members, and internal Metro Plus Health staff.
• Participates in claims related workgroups designed to address claims issues and improve processes.
• Prepares routine reports for the manager on productivity, error rates, complaint rates, financial recordkeeping, and other activities.
• Identifies system processing issues and assist with the root cause analysis process.
• Develops, implements, and maintains claims operation policies, procedures and workflow.
• Assists with the planning, development, and training of claims operations staff.
• Provides input related to the development and performance of employees to Manager.
• Manages daily inventory queues and assigns resources to ensure inventory is processed timely and accurately.
• Monitors daily inventory and assigned claims queues for production and issue identification.
• Generates claims operations dashboard and reports related to inventory and productivity.
• Participates in special projects as needed.
• Other duties as assigned.

Required Education, Training & Professional Experience

• High School Diploma and minimum 7 years of claims operations experience in a healthcare field required; or
• Associate's degree and minimum 5 years of claims operations experience in a healthcare field; or
• Bachelor's degree and minimum 3 years of claims operations experience in a healthcare field.
• Knowledge of claims payment methodologies and policies.
• Knowledge of CMS Regulations
• Proficient in reporting applications, such as Excel, Access or SQL preferred.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication
• Ability to work in a dynamic and fast paced environment.