Claims Supervisor - Management Ancillary Support (CMAS)

Centivo•Buffalo, NY

23d•Hybrid

About The Position

Centivo is seeking a Claims Supervisor in Management Ancillary Services (CMAS). The Supervisor will be responsible for the oversight and management of the claim processing functions related to claims adjudication, appeals, escalations, quality, and recovery. The CMAS Supervisor will have direct management of a team that supports, researches, and resolves the accurate processing of healthcare claims for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement. They will collaborate with internal and external partners to resolve issues and standardize processes, ensuring standard processes are established, policies are enforced, and issues are mitigated through collaborative decision-making.

Requirements

Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims.
Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team.
Analytical Skills: Ability to analyze claims data and make informed decisions based on findings.
Experience: Previous experience in claims processing or a related field, including supervisory experience.
Understands health insurance benefit administration in a Self-Funded environment
Ability to read and understand various forms, documentation, files, and information with the department.
5 years or more experience with healthcare claims administration, self-funded preferred.
Experience leading and delegating tasks to multiple direct reports.
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Must possess proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment.
Proficient experience in MS Word, Excel, Outlook, and PowerPoint required.
Candidates must have prior experience with a highly automated and integrated claim adjudication system; El Dorado-Javelina and/or Health Rules Payer experience preferred but not required.

Nice To Haves

Experience with member appeals, recovery processes, including NSA, subrogation and overpayment process, member, and/or client escalations.
Ability to understand how, and to do thorough research, comfortable interviewing internal expertise and applying the 5 W’s and/or other tools to complete root cause analysis.
Ability to assimilate quickly to the organization or department’s culture and speak in the voice of the brand; able to see the perspective of others and how to translate towards effective solutions.
Ability to take complex issues and break them down so that it can be understood by others; ability to communicate with non-expert audiences.
Strong knowledge of benefit plans, policies, and procedures, understanding of medical terminology.
Strong technical and analytical skills.

Responsibilities

Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans
Ensures that claims, appeals, and adjustments are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
Manages the inventory of claims against standard service level agreements (SLA’s)
Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement.
Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance
Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems
Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance
Liaison for the CMAS Team on various projects and/or initiatives including claims and testing needs to support system implementations and/or upgrades
Performs other duties as deemed essential and necessary