Claims Supervisor

Acentra Health, LLC•Cheyenne, WY

1d•$56,560 - $58,000•Hybrid

About The Position

Acentra Health is looking for a Claims Supervisor to join our growing team. The Claims Supervisor is responsible for overseeing the daily operations of the claims processing team, ensuring timely, accurate, and compliant adjudication of medical claims. Reporting to the Medical Claims Manager, this role provides direct supervision, coaching, and support to Claims Resolution Specialists and related staff while reinforcing operational standards and performance expectations. This position supports the execution of departmental goals by monitoring productivity, resolving escalated claim issues, and ensuring adherence to service level agreements, regulatory requirements, and internal policies. The Claims Supervisor plays a key role in maintaining quality, improving processes, and driving consistency in claims operations. Although not required, this role has a preference for candidates who are able to work on site at our call center in Cheyenne, Wyoming.

Requirements

1+ year(s) of experience in a lead or supervisory role within a claims or healthcare operations setting
Experience in claims resolution, adjustments, and research of claim-related issues
Working knowledge of medical terminology and claims processing standards
Strong attention to detail and ability to ensure accuracy and compliance in a high-volume environment
Effective communication and problem-solving skills with the ability to support and guide team members

Nice To Haves

Bachelor’s degree in healthcare, business, or related field
3+ years of experience in medical claims processing or a similar environment
Familiarity with medical billing forms, ICD-9/10-CM coding, CPT coding, and related coding schemes
Certification in medical coding
Experience in a managed care, Medicaid, or government-regulated claims environment
Experience working in a high-volume claims processing operation
Familiarity with multiple claims systems and data platforms

Responsibilities

Provide direct supervision to claims processing staff, including Claims Resolution Specialists and related roles.
Monitor employee performance and provide regular coaching, feedback, and support.
Support employee development, training, and performance improvement efforts.
Foster a collaborative, accountable, and quality-focused team environment.
Supervise daily operations of claims processing staff to ensure timely and accurate adjudication of claims in accordance with policies and procedures.
Monitor team productivity, quality, and timeliness to ensure service level agreements and performance standards are consistently met.
Review claims, adjustments, and appeals for accuracy, completeness, and compliance with medical necessity and policy guidelines.
Serve as the primary escalation point for complex claim issues, providing guidance and resolution support to team members.
Research claim issues to identify root causes and implement corrective actions to prevent recurrence.
Ensure accurate entry of payment adjustments and proper documentation within claims systems.
Monitor data entry accuracy to support reporting, tracking, and audit readiness.
Provide ongoing coaching, feedback, and development support to team members to improve performance and capability.
Assist in training new hires and reinforcing workflows, policies, and system processes.
Support performance management activities, including evaluations, corrective actions, and recognition.
Identify operational trends and recurring issues and escalate recommendations for process improvements to the Claims Manager.
Troubleshoot claim processing issues across departments, including authorization, appeals, transportation, and financial processing.
Ensure compliance with HIPAA, Medicaid regulations, and applicable privacy and security standards.
Develop and review reports related to productivity, quality, and operational performance.
Communicate effectively with internal stakeholders to resolve inquiries and support operational needs.
Utilize multiple systems and platforms to verify eligibility, claims status, and required documentation.
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.