Claims Supervisor

KHS • Bakersfield, CA

3d

About The Position

Under the supervision of the Claims Manager, the Claims Supervisor will follow organization policies and KHS guidelines; and is responsible for supervising the functions of the day-to-day processing of first-time claims submissions, ensuring the timeliness and accuracy of claims payments.
This position is responsible for supervising the claims processing function for a Knox-Keene licensed health maintenance organization (HMO).

Requirements

• Bachelor's degree in business administration or related field from an accredited institution or equivalent AND two (2) years of administrative or supervisory experience in a medical claim’s payment processing operation.
• OR
• Six (6) years’ experience in medical claims payment processing operation. And two (2) of those years must be supervisory or lead/senior level Claims payment processing position.

Nice To Haves

• Health maintenance organization (HMO) claims payment-processing experience is highly desirable.

Responsibilities

• Leads, trains, develop and evaluate assigned staff. Applies personnel policies and ensures the continual development of staff.
• Manages team production, workloads and priorities.
• Ensures team compliance and adherence to established team performance standards.
• Ensures timely performance measurement and assists in the identification and implementation of improvement initiatives.
• Acts as liaison to Provider Relations, Member Services and Utilization Management on claim issues.
• Researches and resolves provider claims issues as it relates to claims bill and payment issues.
• Responsible for reviewing and releasing high dollar claims, edits and clearing adjustments that the claims processors are not able to release.
• Reviews reports daily to manage claim inventory
• Manages any urgent issues from other areas to ensure that they are resolved in a timely manner.
• Claims point person for issues/concerns on claims related business from other departments, and external customers.
• Attend and participate in internal and external meetings regarding claims related business.
• Keep Manager and Director informed of any issues or concerns.
• Report system issues to the appropriate staff person for resolution.
• Provides support in updating and reviewing completed Claim Policies and Procedures.
• Completes monthly individual performance plan reviews and yearly performance appraisals for staff.
• Provides monthly report to management.
• Perform all other related duties as assigned.
• Assist Director of Claims, Deputy Director of Claims, and Manager of Claims in completing claims related special projects.
• Performs other job-related duties as required
• Adheres to all company policies and procedures relative to employment and job responsibilities

What This Job Offers

• Job Type: Full-time
• Career Level: Manager