Supervisor, Claims (Must reside in FL)

Molina Healthcare•Long Beach, FL

1d•Remote

About The Position

Leads and supervises a team responsible for claims activities, including administering claims payments, maintaining claim records, and providing counsel to Providers regarding coverage amount and benefit interpretation. The role also involves monitoring and controlling the backlog and workflow of claims, ensuring timely settlement in accordance with cost-control standards. This position requires the candidate to reside in Florida.

Requirements

At least 5 years of medical claims processing experience, or equivalent combination of relevant education and experience.
Thorough knowledge of processing outpatient and inpatient facility claims for Medicare, Medicaid, and Marketplace plans.
Research, analysis, data entry, and auditing skills.
Organizational skills and attention to detail.
Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
Ability to work cross-collaboratively in a highly matrixed environment.
Strong customer service experience.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Nice To Haves

Management/leadership experience.

Responsibilities

Coordinates workflow and staffing of day-to-day claims activities and assigns and monitors work of staff in order to adhere to productivity and quality standards.
Hires, onboards, trains, supervises, and develops claims team, and demonstrates accountability for team performance.
Proactively plans for daily claims priorities, and responds to new priorities and process improvement opportunities assigned by leadership.
Ensures execution of claim handling strategies including appropriate determination of coverage, processing guidelines and metrics.
Reviews and analyzes claim reports to identify and address trends; recommends strategies to correct adverse trends.
Effectively manages claims escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
Reviews and documents recommendations for claim disposition including evaluation, negotiation and settlement of claims in excess of staff authority levels.
Compiles and submits daily, weekly and monthly departmental claims reports to leadership.
In collaboration with senior claims leadership, develops claims department initiatives to improve overall efficiency.
Completes claims projects as assigned.