Supervisor, Claims

Zenith American Solutions•San Francisco, CA

19h

About The Position

The Supervisor, Claims provides daily leadership and supervision to a Claims team in accordance with company guidelines, client needs, and regulatory requirements. The role has the minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) for its responsibilities. The supervisor oversees staff performance and claims processing activities, supports client service and implementation, and helps maintain efficient, compliant operations. Depending on location needs, the role may also provide advanced technical claims review and support. The position may involve other duties as assigned, and its duties and responsibilities may change at any time.

Requirements

High school diploma or GED.
Four years of experience processing complex health and welfare claims in a third-party administrator.
One year of experience in a lead or supervisory role.
Advanced knowledge of benefits claims adjudication principles and procedures, medical and/or dental terminology, and ICD-10 and CPT-4 codes.
Thorough knowledge of claims operations, including claims payment, contract interpretation, and benefit communication.
Ability to work effectively as a team player and earn client and internal team confidence.
Integrity and commitment to customer satisfaction.
Ability to communicate clearly and professionally, verbally and in writing.
Strong decision-making and organizational skills, including the ability to optimize available resources and manage multiple priorities.
Exceptional analytical and problem-resolution skills, with the ability to exercise independent, sound judgment.
Computer proficiency, including Microsoft Office tools and applications.

Nice To Haves

Experience working in a multi-employer or Taft-Hartley environment.

Responsibilities

Provide daily leadership and supervision to staff consistent with company values and mission.
Assign, distribute, and monitor the quality and quantity of work; hold employees accountable for quality and production requirements.
Develop staff through performance management, goal setting, training, and effective employee relations.
Maintain current knowledge of assigned plans and oversee processing activities for compliance.
Optimize workflows, processes, tools, and staff allocation for efficient and cost-effective operations.
Troubleshoot customer and client service issues and assist with successful implementation of new clients.
Review and interpret new benefit plans and changes to existing plans; test benefits for validation and accuracy.
Develop and distribute resource documents as needed.
Depending on location needs, provide advanced technical review and support of claims processing.
Review all types of claims, including large-dollar and complex claims, to validate benefit allowance and category.
Investigate, evaluate, and report on advanced third-party recovery cases, including stop-loss, accident, medical malpractice, subrogation, and Workers' Compensation.
Compile documents, records, and data for external audits as requested.
Assist in developing and documenting departmental standard operating procedures (SOPs).
Perform other duties as assigned.