About the Company:
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).
The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.
The Supervisor of Claims is responsible for supervising the Claims staff who ensures the processing of member claims. The Supervisor of Claims must proactively identify issues and problems and seek means for improving the services. Experience with behavioral health or provider relations is highly desirable.
Supervises the processing of claims adjudication and adjustments, production, quality and related reports, and runs and reviews reports as necessary.
Identifies issues and trends related to the quality and productivity for these areas, reports on such, and offers recommendations for improvement.
Implements changes as appropriate, monitors performance on an on-going basis, and addresses any related issues.
Updates departmental policies and procedures and communicates changes to staff.
Coordinates and conducts training and cross-training for all departmental associates and coordinates these activities with other training areas and sites.
Performs or assists with system testing and special projects as needed.
Assigns work to team members on established protocols and criteria.
Acts as a liaison to internal and external customers regarding questions, production, quality and other departmental issues.
Acts as resource to all Operations associates.
Conducts training and cross-training for all departmental associates and coordinates these activities as necessary with other training areas and sites.
Handles all personnel and staffing issues including hiring, performance feedback, performance reviews and evaluations, and addresses staff performance issues.
Performs additional responsibilities as required.
Undergraduate Degree or equivalent work experience required.
Minimum two years experience in an HMO/managed care environment is required.
Experience in, and ability to lead, a high volume production environment is required.
Experience with behavioral health or provider relations, Microsoft Office or similar programs is highly desirable.
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
Short- and long-term disability insurance
Basic Life insurance
Supplemental life insurance
401(k) retirement with company match
Employee stock purchase plan
Vacation, Personal and Sick time
Paid Company Holidays
Employee Assistance Program (EAP)
Training and Learning Opportunities
Tuition Reimbursement/Educational Assistance
On-site fitness center or discount at local fitness centers (most locations)
Discounts for select local and national products and services, including cell phones, computers and more
Other amenities may be available, but vary by location