Claims Supervisor Jobs

About the Role

The Claims Supervisor is responsible for providing coaching, mentoring and training a staff of Claims Examiners while promoting quality and superior customer service. Supervisor is accountable for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.

This is a remote role. We are currently hiring in the following states ONLY: Connecticut, Colorado, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Washington.

Primary Responsibilities

• Research and document pertinent information on claims requiring adjudication. Apply medical policy, contractual provisions and operational procedures to ensure accurate adjudication and/or adjustment.
• Review and process High Dollar claims.
• Assist Customer Service in responding to and resolving customer questions and concerns.
• Perform client requested claim adjustments; provide clear and concise written responses to each client inquiry within specified timeframes.
• Research and respond to escalated issues.
• Provide support to the Client Services department; research and resolve client inquiries.
• Distribution of work to the team daily; Monitors holding inventory to ensure most aged is resolved and followed up on as expected.
• Perform quarterly Performance Evaluations.
• Manage payroll, timesheets, employee schedules and time off requests.
• Provide full-time support as a technical resource for Claims, internal departments, vendors, and customers.
• Provides training to new hires, vendors and existing staff as needed.
• Consistently host individual and team meetings with the team members.
• Helps to create and maintain a safe space for all employees to thrive.
• Perform audits as needed.
• Coach and counsel mentor employees to meet and exceed quality, claims accuracy and productivity standards; identify and work to remove obstacles preventing team members from meeting goals.
• Address and document performance and/or disciplinary issues.
• Perform quality review of claims and logic changes/updates in Impact.

Essential Qualifications

• Bachelor’s Degree preferred or comparable experience in the healthcare field.
• Strong supervisory skills.
• Strong knowledge of contracts, medical terminology, and claims processing and procedures
• Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers and customers.
• Problem solving/analysis.
• Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
• 5+ years of advanced claims adjudication experience including facility, professional and ancillary claims.
• Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
• Organizational skills: ability to effectively prioritize and multitask.
• Advanced knowledge of Microsoft Word and Excel.

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer