Supervisor Claims

Gainwell Technologies LLC • Any city, OH

1d

About The Position

The Supervisor Claims oversees claims program administration and ensures proper claims practices and procedures. The role supervises billing, claims, and related administrative activities to ensure compliance with applicable laws, regulations, policies, agreements, and contractual arrangements. It also supports claims adjustments, investigations, settlements, and the submission and correction of electronic and paper claims.

The supervisor recommends or initiates employee selection and hiring, trains and evaluates employees, addresses performance issues, and makes personnel recommendations to the manager. The role also researches coding and reimbursement requirements to support compliance with local, state, and federal regulations.

Requirements

• Bachelor's degree or an equivalent combination of education and experience.
• Six or more years of claims experience.
• Two or more years of leadership experience.
• Experience with proper claims handling, policies, and procedures.
• Experience with computer-based analysis tools.
• Experience with insurance and/or medical terminology.
• Organizational skills to balance and prioritize work.
• Analytical and problem-solving skills.
• Communication skills.
• Human relations skills to select, develop, mentor, discipline, and reward employees.
• Negotiation skills to interact with claimants.
• Ability to understand and convey applicable laws, regulations, and practices regarding the insurance industry.
• Ability to work independently and lead group activities.

Nice To Haves

• Bachelor's degree in business administration, insurance, or a related field is preferred.

Responsibilities

• Supervise claims program administration to ensure proper claims practices and procedures.
• Supervise billing, claims, and associated administrative activities to ensure compliance with laws, regulations, policies, agreements, and contractual arrangements.
• Assist in implementing procedures for adjusting claims when demographic, sponsor, or charge information is incorrect; monitor and control resubmission of denials, rejections, and appeals.
• Intercede with third parties in unusual situations involving payment or adjustment of account charges, and consult with departments about services affecting charge collection.
• Assist examiners with claims investigations and assist with or conduct settlement negotiations.
• Supervise claim settlement processing.
• Oversee electronic and paper claims submissions, including analysis, correction, and resubmission of registration and eligibility edits and errors.
• Recommend or initiate employee selection and hiring; train and evaluate employees; address performance issues; and recommend personnel actions, salary increases, transfers, and terminations to the manager.
• Research coding and reimbursement requirements for compliance with local, state, and federal regulations.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager