Claims Supervisor

JOB SUMMARY: The Supervisor is responsible for managing the day-to-day planning and operations of the Team. This position is also responsible for serving as a resource for problem solving; staffing, service evaluation and enhancement; and policies/procedures and to ensure efficient operations in a fast-paced environment.

JOB ROLES AND RESPONSIBILITIES:

1. Manage daily operations and processes within the department by monitoring employee workflow and inventory, including distribution of claims/work, when applicable.
2. Train, mentor, motivate, support, and oversee staff performance; including coaching when needed.
3. Monitor compliance with all departmental policies, procedures, and workflows as well as interface with all other internal teams regarding procedural compliance.
4. Monitor departmental and individual performance metrics and take proactive action, when necessary, on a timely basis to maintain desired workflow outputs, acting upon variances when applicable.
5. Develop and implement workflow changes to improve service and production efficiency of the department; this may include collaboration with other teams.
6. Collaborate with the training team and all other internal teams to implement new and revised procedures, which may include suggested system changes or enhancements.
7. Manage and review complex and/or difficult claims or issues to determine best outcome.
8. Partner with internal and external contacts to achieve effective communications and maximum savings.
9. May act as a liaison in monitoring and supporting specific client, provider or departmental assignments through reporting and relationship building.
10. Oversight or research on special projects as assigned.
11. Select, develop, and evaluate staff to ensure the efficient operation of department.
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate Company's Core Competencies and values held within.
15. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
16. The position responsibilities outlined above are in no way to be construed as all encompassing.

Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.

JOB SCOPE: The individual impacts efficiency and effectiveness of team operations. This is a people management role that has the authority to initiate and communicate some HR actions (training, new processes, coaching, mentoring, etc.) but for others, such as hiring, salary adjustments, position change, termination, and other disciplinary actions, the individual collaborates on such issues with the next level. The individual must have the ability to exercise discretion and independent judgment to judiciously act in situations where specific guidelines may not apply.