Supervisor, Claim Operations
Allied Benefit Systems, LLC, United States
Job Description
Job Title: Supervisor, Claim Operations
Department: Claim Department
FLSA Status: Exempt
Job Status: FT
Reports To: Senior Manager, Claim Operations
Positions Supervised: Claim Department Personnel
Work Schedule: Flexible full-time hours
Assessments: PI Behavioral and Cognitive
POSITION SUMMARY
Assist the Management Team with the monitoring and management of the daily work and other functions within the Department as well as training for new and existing department staff. Planning and maintaining workflows, procedures and policies that enable and encourage the optimum performance of the team.
ESSENTIAL FUNCTIONS
- Coach, mentor, and develop staff, including training/overseeing new employees.
- Empower employees to take responsibility for their jobs and goals.
- Lead employees using a performance management and development process that provides an overall context and framework to encourage employee contribution and includes goal setting, feedback, and performance development planning.
- 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 but not limited to HIPAA, HITECH and any regulations promulgated thereto.
- Assist other departments on questions related to the payment of claims.
- Monitor all reports including but not limited to Workflow Manager, Pended claims, Suspended claims, Inventory listings, Audits and Automation to ensure that all workflows are followed.
- Perform other duties and responsibilities, as assigned.
- Attend continuing education classes as required, including but not limited to HIPAA training.
POSITION QUALIFICATIONS
Communication Communicates effectively both internally and externally, where applicable. Includes both written and verbal communication.
Employee Management Defines responsibilities, motivates employees, delegates well and rewards appropriately.
Initiative Takes action independently, seeks new opportunities, and strives to see projects to completion.
Innovation Creative, offers new ideas, risk taker and amenable to change.
Interpersonal Skills Builds strong relationships, is flexible/adaptable, works well with others, and solicits feedback.
Job Knowledge Understands the facets of job, aware of duties and responsibilities, and keeps job knowledge current.
Leadership Provides strong leadership, sets a good example as a skilled decision maker, motivator and encourager.
Problem Solving Strives to understand contributing factors, works to resolve complex situations.
Productivity Manages workload, works efficiently, and meets goals and objectives.
Quality Strives to eliminate errors, accurate work is a priority, seeks opportunities to improve product/services
Self-Development Looks for opportunities to increase knowledge, works to increase responsibility, strives to achieve personal goals and/or maintains licenses and other pertinent requirements.
Teamwork Accountable to team, works to meet established deliverables, appreciates view of team members, and respectful.
Technical Skills Maintains current understanding of technical process/equipment, uses technology to increase performance/productivity; effectively uses online tools and resources.
Requirements
SKILLS amp; ABILITIES
All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology. Continuing education in all areas affecting group health and welfare plans is required. Applicants must demonstrate the ability to supervise tasks and contribute to the Team atmosphere and concept.
Experience
Applicants must have a minimum of 5 years of medical claims analysis and adjudication experience (including dental and vision claims analysis). Prior experience in management and training is preferred but not required.
Certifications
N/A
Education
High School Diploma, College and Advanced Degrees Preferred.
Physical Demands
The employee is regularly required to sit, talk, or hear; frequently required to use repetitive hand motion.
WORK ENVIRONMENT
This will be an off-site position with the applicant providing their own internet service. Interviews, training, meetings and other key tasks may require the employee to