Claims Supervisor

UNITE HERE HEALTH•Oak Brook, IL

2d•Hybrid

About The Position

The Claims Supervisor will oversee the claims production team who is scanning, uploading and keying in UNITE HERE HEALTH's member’s and dependent’s medical, vision, dental and short-term disability claims related correspondence. This position is responsible for the accuracy and timeliness of handling of claims and member correspondence based on the guidelines set forth by the Department of Labor. The Claims Supervisor is responsible for partnering with internal and external parties to ensure that the turnaround times are met, which includes, but is not limited to the BlueCross and BlueShield incentive. This position is relied upon as a subject matter expert for creating and updating provider records, Coordination of Benefits provisions and eligibility-related inquiries within the Department; this includes providing support to the Legal Team as it relates to subrogation files. The Claims Supervisor supports the production team through functions in collaboration and coordination with other teams, including New Membership, Member Services and C&E teams. To provide daily support to the Claims Department through updates to members COB information and providers records in the claims processing system. This position provides development, training, and coaching to employees for guidance and direction to ensure that a high level of accountability and performance is delivered to our participants.

Requirements

Bachelor's degree in related field or equivalent work experience required
4 ~ 6 years of direct experience minimum
3 ~ 5 years of supervisory experience required
Intermediate level Microsoft Office and Excel skills
Professional level training that provides working knowledge of:
Administration of welfare plan benefits
High degree of Claims Processing Knowledge
Understanding of Medicare, Medicaid, ACA, DOL regulations, ERISA and HIPAA
Audit and billing procedures
Plan documents and summary plan descriptions
Vendor relations
Eligibility rules

Nice To Haves

Preferred fluency (speak and write) in Spanish

Responsibilities

Provides leadership, motivates, advocates, coaches and develops team performance and promotes Fund culture/mission along with advocating for appropriate change with a positive attitude
Holds direct reports accountable for individual performance, which may result in disciplinary action
Promotes operational efficiency and quality by critically analyzing team processes with the intention of improving member experience and creating a high level of consistency in the team’s quality and production results.
Manages and reports on team inventory to ensure that departmental metrics are met
Successfully investigates and responds to escalated inquiries from internal and external sources
Allocates and cross trains team resources to complete goals
Assists in training to other UHH operational areas
Collaborates and partners with other Claims Department Supervisors to ensure consistency in processing across all teams and to identify ways to be BETTER, more efficient, adaptable and participant focused
Ensures adherence to policies and procedures are consistently applied
Assists in the design and preparation of management reports
Collaborates with the Legal team to understand legal regulations and plan provisions
Demonstrates necessary competence in technical, industry standard and soft skills to effectively support and develop staff
Communicates with Executive Leadership through creation of the monthly Claims Department Dashboard.
Interacts with members and UHH operational areas to resolve complex issues
Interacts with members and UHH operational areas to educate regarding policies and procedures
Strictly adheres to all regulatory and legal requirements, including time deadlines
Ensures members Coordination of Benefits information is accurately and consistently updated and maintained
Oversees the creation and maintenance of provider records for accuracy and claim payments, as well as, annual 1099 reporting to IRS
Demonstrates personal accountability for personal actions as well as team and departmental results through ensuring claims and correspondence are handled in accordance with the guidelines set forth by the DOL and our internal Claims Policy Committee
Plans, analyzes, and evaluates programs and services, operational needs, and fiscal constraints
Supervises, leads, and delegates work and coaches, mentors, develops employees
Analyzes problems, identifies and develops alternative solutions, projects consequences of proposed actions and implements recommendation/solutions
Recommends hires and promotions, directs and evaluates employment decisions for all assigned positions
Assists with developing and coordinating policies and procedures
Responsible for the oversight of continued employee training requirements, safety and quality initiatives