Claims Supervisor- Bakersfield 1.1
About The Position
The Claims Supervisor provides hands-on leadership and operational oversight within the Claims Department, ensuring timely, accurate, and compliant claims and encounter processing. This role supervises staff, monitors productivity and quality standards, manages claims inventory, and supports workflow efficiency. The Claims Supervisor works closely with internal departments, including Enrollment and Information Technology, to support accurate adjudication and effective system functionality. This position helps implement operational improvements, staff training, and process enhancements while maintaining compliance with regulatory and contractual requirements.
Requirements
- High School Diploma or GED required, associate or bachelor’s degree in healthcare administration, Business, or a related field preferred.
- Minimum of 5 years of experience processing professional and institutional claims within a managed care environment, preferably in an IPA or medical group setting.
- Supervisory experience preferred, including coaching and workflow oversight.
- Strong knowledge of professional and institutional claim processing.
- Knowledge of fee schedules and pricing methodologies for inpatient, outpatient, ancillary, and professional claims.
- Familiarity with CMS, DMHC, and DHS regulations.
- Coding certification (CPC, CCS, or equivalent) strongly preferred.
- Experience with claims systems and workflow automation.
- Understanding of health plan financial responsibility structures and provider contract interpretation.
- Strong organizational, analytical, and communication skills.
- Proficiency in Microsoft Excel, Word, and email.
- Possession of a valid driver's license.
- Proof of state-required auto liability insurance.
Nice To Haves
- associate or bachelor’s degree in healthcare administration, Business, or a related field preferred.
- Supervisory experience preferred, including coaching and workflow oversight.
- Coding certification (CPC, CCS, or equivalent) strongly preferred.
Responsibilities
- Supervise daily claims operations, ensuring timely, accurate processing of claims and encounters.
- Monitor claims inventory and production reports to maintain productivity and quality standards.
- Coach, train, and provide performance feedback to claims staff.
- Support adherence to claims workflows, policies, and procedures.
- Ensure compliance with regulatory, contractual, and health plan requirements.
- Identify staff training needs and coordinate appropriate support.
- Collaborate with Enrollment and internal departments to ensure accurate claim processing.
- Assist in troubleshooting system issues and support process improvement initiatives.
- Provide feedback to management on workflow, productivity, and operational challenges.
- Participate in departmental meetings and support cross-functional initiatives as needed.
- Assist with onboarding and performance management of claims staff.
- Ensure staff have the tools and resources needed to perform their job functions.
- Perform other related duties as assigned.
Benefits
- Medical
- Dental
- Vision
- Paid Time Off (PTO)
- Floating Holiday
- Simple IRA Plan with a 3% Employer Contribution
- Employer Paid Life Insurance
- Employee Assistance Program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
