Supervisor, Managed Care Claims
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About The Position
The Supervisor, Managed Care Claims is responsible for the supervision of Commercial claims adjudication. Essential job functions include ensuring that quality and productivity standards are achieved, creating daily work plans specific to inventory objectives, and working collaboratively with leaders to develop training and in-service initiatives. The role also involves overseeing all quality improvement initiatives for the Claims unit and the Provider Service Unit to ensure that service objectives are met. Additionally, the supervisor will identify provider-billing issues via claims service trends and communicate these to the Senior Contract Manager for provider education. Other responsibilities include supervising auditing activities, evaluating trends, and managing the supervision of Resolute to Tapestry commercial claims and Health Plan Claim Delegation agreements, including annual audits and resolution of corrective action plans. The supervisor will also provide support for Resolute to Tapestry claims, lead COB/Recovery tasks including analysis and reporting, and supervise auto-adjudication activity. Maintaining applicable policies and procedures, coordinating staff participation in testing, creating and distributing operational reports, and exhibiting leadership qualities through performance, appearance, and demeanor are also key aspects of this position. Employee relations tasks including development and coaching are part of the role, along with other duties as assigned.
