Claims Supervisor

Description

SUMMARY: The Claims Supervisor is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. The incumbent monitors processed claims by performing the following duties.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Compares data on claim application with policy and other company records to ascertain completeness and validity of the claim
• Ensures all over-dollar claims are coded and priced properly
• Coordinates with Claims Auditor on individual examiner’s audit results to identify areas of training and development
• Tracks errors and reports to Manager monthly
• Provides ongoing training to team members to maintain high quality standards
• Ensures team performs to quality and productivity standards
• Contacts doctors, lawyers, carriers or others involved to resolve claim/coverage questions
• Corresponds with examiners and claimants to correct errors or omissions on claim forms, and to investigate questionable entries
• Reviews and monitors all monthly reports to ensure claims are not aging, duplicated, and that all ineligible claims are reprocessed
• Provides monthly reports and statistics as required
• Develop processing guides and workflow documents
  
  

Performs Other Duties And Responsibilities As Assigned By Management

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate. . Fast-paced and deadline-driven. May require extended hours during peak claim periods or audits.

Requirements

Knowledge, Skills, & Abilities:

• Ability to provide feedback effectively and coach employee’s on improving job performance
• Excellent written and verbal communication skills
• Strong analytical skills and problem-solving skills
• Must be dependable and maintain excellent attendance
• Subject-matter expert within field
• Must be able to perform data entry operations quickly and accurately
• Ability to grow with changing demands of the position and the company
• Strong computer skills, including proprietary claims software, Word, Excel, and Outlook
• Proficiency in using spreadsheet software (e.g., Excel) for data organization and calculations, including formulas and functions.
  
  

Supervisory Responsibilities

Will directly supervise 10-15 team members. Will be responsible for all supervisory duties including time & attendance, coaching, disciplinary actions, and performance appraisal. Ensures all direct reports execute objectives using a developmental plan (ninety (90) day plan) and regular performance reviews, posting productivity, quality and deadline results.

Will monitor time and attendance for all direct reports by comparing production to hours worked- will report on productivity, deadlines and quality results accordingly.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/or Experience

High school diploma or general education degree (GED); minimum three years related experience and/or training; or equivalent combination of education and experience.

Language Skills

Ability to read, speak, and write effectively in English. Ability to interpret documents such as statements, invoices, Summary Plan Documents, memos, letters, and procedure manuals. Ability to write routine reports and correspondence. Significant verbal communication skills are required in order to coach employees, provide feedback, and explain problems and solutions in an easy to understand manner. Ability to communicate effectively, verbally and in writing with clients, carriers, members, and attorneys. Ability to effectively address or resolve customer service issues within guidelines of the position

Mathematical Skills

Ability to add and subtract, multiply and divide with large amounts. Proficient in calculating percentages, decimals, and fractions.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to methodically break down complex issues and formulate effective solutions.

Certificates, Licenses, Registrations

N/A

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.