Supervisor, Claims

Emergent Holdings•Lansing, MI

About The Position

The Claims Supervisor is responsible for guiding work coming into and going out of the Claims Department, which may include developing a timeline for projects and delegating components to members of the team, including him/herself. The Claims Supervisor often provides information to the Claims Manager or updates the company on the team’s progress in meetings or through regular email contact or reports.

Requirements

Bachelor’s degree in Business Administration, Computer Science, Information Technology, Health Care or other related field preferred. Relevant combination of education and experience may be considered in lieu of degree. Certification or progress toward certification is highly preferred and encouraged.
Five years’ experience of Advantasure Platform systems experience with demonstrated technical knowledge that provides the necessary skills, knowledge and abilities. Claims background in a Medicare Advantage Organization preferred. Two years of supervisory experience required. Previous experience of claims analyst using facets, or equivalent, for claims and enrollment systems preferred.
Knowledge of Medicare Advantage processes and Centers for Medicare & Medicaid Services (CMS) guidelines.
Knowledge and experience of the standard Life Cycle of a Claim
Experience in the Claim Adjudication process for medical claim processing editing, pricing and procedures
Excellent verbal and written communication skills with an ability to disseminate information in an effective manner. Excellent interpersonal skills and ability to interact with employees at different levels within the organization.
Strong analytical skills with high attention to detail.
Ability to be flexible and work under tight deadlines.
Ability to work independently, as well as with all levels of staff, leadership, and external partners and vendors.
A strong working knowledge of Microsoft office products.
Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
Ability to work with and empower others on a collaborative basis to ensure success of unit team.
Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
Ability to effectively present budgetary and/or cost information, and respond to questions as appropriate.
Ability to establish workflows, manage multiple projects, and meet necessary deadlines.

Responsibilities

Supervise a team of Claims Specialists and others claim roles
Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.
Identifies and/or analyzes business problems and devise procedures for solutions to the problems.
Develops and maintains an effective working relationship with customers.
Effectively leads projects/teams in order to produce desired results.
Responsible for corporate communication of project results.
Develops and implements desk levels and policies and procedures for deviations of Advantasure standard processes.
Participate in the CMS audit of MA plans performance.
Manages daily inventory and Turnaround of claims inventory
Handle and resolve escalated phone calls/issues
Work to resolve individual conflicts and problems with a specific project or task
Provide Manager with information regarding performance of members of the Claims Team
Work with Human Resources to coordinate interviewing, hiring, and development of new hires to department
Coordinate with Vendors within the Claims system
Coordinate with Account Managers/Eligibility/Provider Relations, etc.
Responsible for daily production (Individual)
Respond to subject matter expertise questions as needed
Approve and manage employee time sheets
Performs and holds 1:1 and Team meetings on a regular and consistent basis
Interacts, coaches, counsels, and trains a staff of claims examiners and supporting roles in accordance with company policies and applicable labor laws.
Address and document performance issues; coach or discipline employees as necessary