Claims Supervisor - Hybrid - 139765

The Claims Supervisor is responsible for direct, day to day oversight of the claim examiners who report directly to this position. The Claims Supervisor serves as the primary point of contact and subject matter expert for the claims team and functions as the go to operational resource for daily claim processing activities. The Claims Supervisor's focus is on execution and consistency within established workflows. Specifically:

• Provides hands on guidance, clarification, and training to frontline claim examiners
• Supports real time problem solving related to individual claims and processing workflows
• Closely monitors claim turnaround times, quality metrics, and productivity
• Distributes and prioritizes work to ensure departmental performance standards are met
• Ensures claims are processed accurately and timely according to defined procedures

Participates in short and long-range planning for the department. Encourages growth and development among staff and serves as role model in areas of appropriate work ethics and professionalism. Establishes and maintains positive relationships with internal departments and internal/external customers. Assists Claims Manager with development, maintenance, monitoring and review of reporting metrics and tools to meet payor delegation and regulatory requirements. Serves as one of the primary points of contact for IT regarding system and software upgrades, testing and implementation. Performs other related duties and projects as assigned. Job standards are to be performed at the EXPERT level.

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training.

• Strong interpersonal and customer service skills, with the ability to cultivate and maintain constructive working relationships with both internal and external constituencies

• Proven analytical, critical-thinking, and problem-solving skills, with the ability to assess complex problems, respond effectively to questions and concerns, and identify and present potential solutions.

• Strong detail orientation, organizational and project management skills to negotiate, manage, and track complex managed care contracts

• Highly proficient with MS Office (Word, Excel, PowerPoint, Outlook),specialized contract databases and managed care systems.

• Minimum of 2 years' experience processing claims within Epic Tapestry.

• Ability to provide effective direction to Claims Examiners on claim adjudication protocols.

• Lead and/or Supervisory experience.

• Expert knowledge of and experience with HMO claims processing for Commercial and Senior lines of business.

• Strong knowledge of managed care claim regulatory and delegation requirements.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.