Claims Clerk Supervisor

Advanced Medical Management•Long Beach, CA

2d•$0 - $80,000•Onsite

About The Position

The Claims Clerk Supervisor leads the daily clerical and claims-support operations of the Claims department, guiding a team of claims clerks through intake, imaging, data entry, adjustment, correspondence, and appeals-support workflows. Working under the Manager of Claims Operations, this role serves as a subject-matter expert on claims reprocessing and clerical procedures, drives quality and payment accuracy, and supports internal audits and compliance readiness. The position operates in a modern, largely paperless claims environment built on electronic claim intake (EDI 837), electronic remittance (835), clearinghouse and health-plan portals, and digital document management. The Supervisor is expected to be comfortable adopting and working alongside AI-based and automation tools — such as intelligent document processing (OCR/indexing), auto-adjudication and exception-queue routing, and AI assistants that help draft correspondence, summarize claim and appeal history, and flag anomalies — while exercising sound judgment, validating tool output, and safeguarding protected health information (PHI) in accordance with HIPAA and company policy.

Requirements

High school diploma or GED required
Four to six years of healthcare claims processing / claims operations experience, including at least one to two years in a lead, senior, or supervisory capacity.
Working knowledge of Medicare, Medicaid, and Commercial claims-processing guidelines
Proficiency with CPT, HCPCS, ICD-10-CM coding and RBRVS methodology
Comfortable learning and using AI-assisted and automation tools in a claims setting, with good judgment about validating output and protecting PHI.
Strong knowledge of claims-processing rules, guidelines, and clerical workflows; high accuracy and attention to detail.
Highly organized, able to prioritize and perform multiple tasks efficiently in a fast-paced, deadline-driven environment.
Computer literate and quick to learn new systems; proficient with Microsoft 365 (Outlook, Excel, Teams), electronic fax, SFTP/portals, and document imaging.
Clear written and verbal communication; able to work effectively with all levels of staff, providers, and health plans.
Sound judgment handling PHI; commitment to HIPAA compliance and data security.

Nice To Haves

associate’s degree (or equivalent coursework) in healthcare administration, business, or a related field preferred.
managed-care / IPA or delegated-claims experience preferred.
a coding credential (e.g., CPC, CCS) is a plus.
Revenue-recovery experience is a plus.
Experience with a claims administration platform such as EZ-CAP and a document-management/imaging system such as OnBase (Hyland) is strongly preferred.

Responsibilities

Supervise, train, and mentor claims clerks; serve as the subject-matter expert on claims reprocessing and daily clerical procedures.
Assign and balance daily workloads, monitor productivity and turnaround times, and ensure end-of-day close-out (batch cover sheets, log sheets, and the end-of-day email) is completed accurately.
Communicate effectively with the Claims Manager and production staff, and coordinate with client services, external vendors, health plans, and other organizations to resolve claims issues.
Oversee claims batching, filing of data-entered claims, and daily retrieval of health-plan files (e.g., pulling claims from the Humana SFTP/FTP and health-plan portals).
Manage document imaging in OnBase and the Mail Room Scan Folder, including separation and scanning of multiple medical records (Mult MR), and use of OCR/intelligent document processing to index and route images for processing.
Administer fax intake and distribution (RingCentral, fax folders) and ensure all source documents are captured and stored for adjudication.
Perform and supervise data entry of CMS-1500 (HCFA) and UB-04 (UC) claims into EZ-CAP, and process corrected claims (MEDRVW) to meet turnaround-time standards.
Apply adjustment codes, process copay reversals, resolve invalid billing formats / rejected claims and invalid NDCs, and correctly distinguish first-time claims from adjustments (e.g., Anaheim Global MEC vs. first-time claim).
Work assigned queues and status codes (e.g., UDUNC, 252, 16), apply PS note codes accurately, and generate member/provider notices using the EOB Writer.
Support the appeals and grievance (A&G) process: intake of paper and electronic appeals, maintenance of the Appeals Data Entry Log, and pairing appeals with the associated claim image.
Forward Provider Dispute Resolutions (PDRs) appropriately (requires working knowledge of the PDR process) and respond to Health Plan Demand Inquiries.
Prepare and track development correspondence — 1st and 2nd request letters for developed claims (mailed and email requests) and forwarding of letters for claims denied under B11.
Perform eligibility look-ups and submit eligibility verification requests to confirm coverage prior to adjudication.
Submit and follow up on provider and hospital add requests to keep provider and facility data accurate.
Audit claims-processing quality; develop, maintain, and run standard and ad-hoc reports to identify root causes and improvement opportunities.
Support the claims compliance team in preparing for internal and external audits; research and document special conditions or additional requirements affecting adjudication.
Monitor paper claims submitted and reconcile intake against system totals.
Use standardized processes, tools, templates, and productivity software (Microsoft 365, Teams) to manage projects, timelines, and issue tracking; submit and follow up on Help Desk tickets.
Adopt and champion AI-based and automation tools that improve speed and accuracy — always reviewing and validating AI-generated output before it is relied upon, and never entering PHI into non-approved tools.
Participate in special claims projects (including STAR/annual-wellness claim processing) and recommend workflow improvements.
Perform other duties as assigned.