Supervisor, Claims

Zenith American Solutions•San Francisco, CA

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 minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) based on the job description and role. The supervisor assigns and monitors work, develops staff, oversees claims processing compliance, and improves workflows and resource allocation. The position may also provide advanced technical claims review depending on location needs, investigate advanced third-party recovery cases, support audits, and assist with departmental procedures. Other duties may be assigned.

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 communication of benefits.
Team-oriented, with the confidence and integrity to earn client and internal team confidence quickly.
Highly developed sense of 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 deliver on multiple priorities.
Exceptional analytical and problem-resolution skills, with the ability to exercise independent, sound judgment.
Computer proficiency, including Microsoft Office tools and applications.
Ability to sit for prolonged periods at a desk and work on a computer.
Ability to lift up to 15 pounds at times.

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, holding 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 to ensure compliance.
Optimize workflows, processes, tools, and staff allocation for efficient and cost-effective daily 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.
Technically 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 SOPs.
Perform other duties as assigned.