Coordination of Benefits - Supervisor

Claritev•New York, NY

18d

About The Position

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! JOB SUMMARY This role ensures timely, accurate processing of all aspects of the identification, investigation, and validation processes for Coordination of Benefits (COB) and related eligibility products. The position monitors, prioritizes and distributes work to assigned team(s). The incumbent will work to facilitate quality processing of cases according to policy and procedures and client service level agreements (SLA's). This individual will work to identify recoveries for assigned clients that meet or exceed forecasts and partnering with senior leadership to execute on short and long term production strategies.

Requirements

Minimum high school diploma plus five (5) years experience in healthcare/insurance operations, coordination of benefits, or claims processing environment; two (2) years' of which should be inclusive of supervisory or other leadership experience.
History of demonstrated client focus and ability to achieve results.
Required licensures, professional certifications, and/or Board certifications as applicable.
Clinical jobs require post-graduate experience in direct patient care, board certification for MD/DO (Medical Doctor/Doctor of Osteopathic Medicine), and an unrestricted clinical license.
Good organizational, analytical and independent decision making skills.
Strong problem solving skills with the ability to manage multiple priorities and meet associated timelines.
Proficient with MS Office products including Microsoft Excel.
Specifications should support the essential functions identified in the job, assuring compliance with the Americans with Disabilities Act (ADA) and other such employment-related acts (i.e., ability to stand for long periods of time, ability to interact with customers or visitors, ability to lift up to 50 pounds, ability to travel).
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

Responsibilities

Schedules and prioritizes work, approve time off, conducts performance reviews, hires, and trains new employees, and performs other supervisory responsibilities and enforces production, quality, and customer-service standards / SLAs. Addresses issues with the team as a whole and individually.
Primary point of contact for offshore contractors, including but not limited to the following: hiring for correct skillset, work assignment, approving hours, coordinating training, mitigating vendor specific issues, and working with vendor management to drive acceptable results.
Partners with senior leadership to draft, develop, and implement policies, procedures, and strategies to improve department metrics and relevant KPIs.
Routinely utilizes expertise specific to coordination of benefits rules, regulations, methodologies, and audit tactics to ensure efficient day-to-day operation of the department.
Ensures compliance with CMS, NAIC and state COB guidelines. Ensures team is following company and client expectations.
Works closely with senior leadership to document policies, procedures, and processes. Maintains and improves COB/OHI processes by monitoring trends and addressing issues for process improvement.
Must maintain a high level of confidentiality in dealing with protected health information and ensure that teams do the same.
Fields client issues and complaints and decides on a course of action to resolve the matters.
Select, develop, and evaluate staff to ensure the efficient operation of department.
Collaborate, coordinate, and communicate across disciplines and departments.
Ensure compliance with HIPAA regulations and requirements.
Demonstrate Company's Core Competencies and values held within.
Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Benefits

Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off – accrued based on years of service
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits