Supervisor, Claims Processing - Covered California

IEHP • California, MD

50d • Remote

About The Position

The Supervisor, Claims Processing - Covered California provides daily oversight of claims staff, business processes and inventory management. This role ensures that the claims team follows state/federal regulations and standard operating procedures. The Claims Processing Supervisor - Covered California develops best practices to optimize claim processing quality. This person also evaluates professional skills of team members and provides appropriate work assignments, as well as resolve claim payment issues and quality oversight. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

• Minimum of four (4) years of medical claims processing experience, of which at least two (2) years of experience in a supervisory capacity leading a team
• This should also be inclusive of three (3) years of experience in a managed care environment
• The person in this role should also be experienced in benefit and financial matrix interpretation.
• High School diploma or GED required

Nice To Haves

• Experience in an HMO or Managed Care setting. Medicare, Commercial and/or Medi-Cal experience preferred. Prior experience in a lead role or customer service environment is a plus
• Bachelor's degree from an accredited institution preferred
• A thorough understanding of claims industry and customer service standards
• Knowledge in CMS, DHMC and DHCS regulatory guidelines including AB1455
• Extensive knowledge of ICD-9, ICD-10, CPT, and Revenue Codes
• Solid understanding of the DHCS, DMHC and CMS rules and regulations governing claims adjudication practices and procedures desired
• Knowledge in Commercial and Exchange policy and procedures
• Principles and techniques of supervision and training
• Knowledge of medical terminology and understanding of healthcare claims
• Analytical skills with emphasis on time management, database maintenance, spreadsheet manipulation, and problem solving
• Strong writing, organizational, project management, and communication skills proficiency required
• Excellent interpersonal and communication skills
• Must have a high degree of patience and ability to lead a large team of professionals

Responsibilities

• Provides daily oversight of claims staff
• Provides daily oversight of business processes
• Provides daily oversight of inventory management
• Ensures that the claims team follows state/federal regulations
• Ensures that the claims team follows standard operating procedures
• Develops best practices to optimize claim processing quality
• Evaluates professional skills of team members
• Provides appropriate work assignments
• Resolves claim payment issues
• Provides quality oversight

Benefits

• Competitive salary
• Telecommute schedule
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account - Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees