Medical Claims Supervisor

ImageNetLLC•Boise, ID

1d•Remote

About The Position

The Claims Supervisor is responsible for the overall operational performance, client satisfaction, reporting oversight, KPI ownership, and frontline leadership of assigned healthcare claims accounts. This role is accountable for ensuring all production, quality, turnaround time, attendance, and client service expectations are consistently achieved. The Supervisor will oversee Team Leads and Claims Examiners while serving as a key operational partner to clients, internal leadership, QA, Training, Training, Workforce, and Account Management teams. This individual must be highly accountable, data-driven, proactive, and capable of managing both operational execution and client relationships in a fast-paced environment. The Supervisor is expected to identify operational risks before escalation, own account performance outcomes, drive remediation efforts, and maintain strong client confidence throughout the engagement lifecycle.

Requirements

Minimum 3–5 years of healthcare claims leadership experience.
Prior supervisory experience overseeing production teams required.
Strong experience managing healthcare payer operations and claims workflows.
Experience with client-facing operations and client relationship management.
Strong reporting and data analysis experience required.
Experience owning operational KPIs and performance deliverables.
Strong leadership, accountability, organizational, and communication skills.
Intermediate to advanced Excel and reporting/dashboard experience required.

Nice To Haves

Experience with systems such as EZ-CAP, QNXT, Facets, Jiva, Plexis, or similar preferred.
Experience managing offshore and/or remote teams preferred.

Responsibilities

Oversee daily claims operations across assigned accounts and lines of business.
Own operational performance and ensure all KPIs, SLAs, and client deliverables are achieved consistently.
Drive accountability across Team Leads and frontline staff for production, quality, attendance, and adherence expectations.
Monitor inventory levels, aging, turnaround times, backlog risks, and workflow distribution proactively.
Develop and execute remediation plans for missed targets or operational gaps.
Ensure operational readiness during implementations, transitions, and account expansions.
Partner with Workforce Management and Operations leadership on staffing models and capacity planning.
Will go through training with the team members and expected to perform at the highest level in training.
Maintain direct ownership of account-level KPIs and operational metrics.
Analyze trends and provide action plans for: Productivity, Quality, Error rates, Turnaround times, SLA compliance, Attendance/adherence, Inventory aging, Client escalations.
Hold Team Leads and staff accountable for achieving performance expectations.
Conduct recurring performance reviews, coaching sessions, corrective actions, and performance improvement plans.
Ensure performance issues are addressed timely and consistently.
Establish a culture of urgency, accountability, and continuous improvement.
Serve as a key operational contact for assigned client accounts.
Participate in client meetings, operational reviews, calibrations, and business discussions. Specifically weekly, monthly and quarterly business reviews.
Build and maintain strong client relationships through operational execution and proactive communication.
Ensure client concerns and escalations are addressed timely with clear ownership and follow-through.
Partner with Account Management and Leadership to maintain high client satisfaction and retention.
Support implementation activities and client onboarding readiness.
Prepare, analyze, and present operational reports and KPI dashboards.
Deliver accurate and timely reporting to clients and internal leadership.
Analyze production trends, staffing performance, quality trends, and operational risks.
Ensure reporting integrity and visibility into operational performance.
Utilize reporting tools such as Excel, Power BI, client systems, and operational dashboards.
Present operational findings, action plans, and improvement initiatives clearly and professionally.
Ensure compliance with client guidelines, HIPAA, CMS regulations, and internal policies.
Partner with QA teams on calibrations, error trending, and quality remediation efforts.
Identify root causes of operational issues and implement corrective action plans.
Drive process improvement initiatives to improve productivity, quality, and efficiency.
Support audit readiness and compliance initiatives.
Mentor, coach, and develop Team Leads and frontline staff.
Ensure proper onboarding, nesting, and ongoing development of employees.
Reinforce operational expectations and leadership accountability.
Support succession planning and internal talent development.
Promote a culture of professionalism, ownership, teamwork, and accountability.