Supervisor - Claims Systems

Worldwide Insurance Services•King of Prussia, PA

19h•Hybrid

About The Position

The Supervisor, Claims Systems is a hybrid leadership and hands-on role responsible for the day-to-day operation, support, and continuous improvement of claims administration systems. This position combines direct oversight of a team with active involvement in system configuration, issue resolution, and implementation activities. The role ensures claims systems operate accurately, efficiently, and in compliance with business and regulatory requirements, while also contributing directly to key system initiatives and operational deliverables.

Requirements

1+ years of leadership experience
2+ years of experience in claims operations, claims systems, or business systems analysis within healthcare or insurance
Experience working with claims administration platforms (e.g., Actisure, Guidewire, or similar systems)
Experience supporting system implementations, enhancements, and testing activities
Strong understanding of claims processing workflows and system configurations
Experience translating business requirements into system specifications
Proficiency in data analysis and reporting (e.g., Excel, SQL, or similar tools preferred)
Familiarity with system testing methodologies (UAT, regression testing)
Ability to translate business and product requirements into operational system solutions.
Knowledge of claims lifecycle, benefit structures, and eligibility processes
Understanding of regulatory and compliance requirements impacting claims processing
Exposure to payment integrity and reconciliation processes preferred

Responsibilities

Oversee daily operation and performance of claims administration systems, including Actisure and related platforms
Perform hands-on system configuration and maintenance, including benefit plans, provider setup, code sets, user roles, permissions, and claims correspondence
Monitor system functionality and directly address issues impacting claims processing accuracy, timeliness, and compliance
Maintain system controls and ensure adherence to operational standards
Translate business and operational changes (e.g., new products, benefit updates, enrollment changes, regulatory requirements) into system requirements
Configure, review, and validate system updates to ensure accuracy prior to release
Participate directly in system build, testing, and validation activities
Ensure alignment between Enrollment and Claims for eligibility, benefits, and adjudication logic
Collaborate with IT, Product, Enrollment, Finance, Compliance, and vendors on system enhancements, upgrades, integrations, and defect resolution
Lead and execute user acceptance testing (UAT), including test planning, scripting, execution, and defect resolution and support implementation readiness and perform post-release validation activities
Serve as a primary point of contact for Claims Systems-related questions, issues, and initiatives.
Ensure claims systems and configurations comply with regulatory requirements, contractual obligations, and internal policies
Participate in and support audits (e.g., SOC and other internal/external audits), including documentation, testing, and remediation
Monitor system performance and operational trends; take direct action to resolve risks and control gaps.
Supervise and support a team of claims system analysts while also carrying an individual workload
Assign and prioritize teamwork alongside personal responsibilities to ensure timely delivery of system updates and issue resolution
Provide coaching, guidance, and feedback while reinforcing accountability and quality of work
Step in to perform analyst-level work as needed to support team capacity and critical initiatives

Benefits

Competitive base pay + annual bonus
Competitive medical plans
Telemedicine available
Paid parental leave
Employee assistance and wellness support 24/7
Free international healthcare coverage
Work abroad arrangements available
Generous PTO accrual program with carry-over option
9 paid holidays in addition to one floating holiday and one volunteer day
Tuition reimbursement
Career/Learning and development opportunities
401(k) with generous company match
Pet insurance offerings
Identity theft and legal coverages available
Emphasis on well-being (Virtual well-being platform, monthly mindfulness events, and giveaways)