Claims Supervisor

The role

The Claims Supervisor will lead a team of Claims Processors to ensure accurate and efficient claims processing for employer-sponsored health plans. This role involves setting productivity benchmarks, enforcing quality standards, and managing claim inventory against service level agreements.

What you will do

• Ensures claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
• Manages the inventory of claims against standard service level agreements (SLAs)
• Educates and mentors claims staff to ensure proper application of client benefit plans
• Establishes performance plans for staff falling below expectations through coaching and mentoring
• Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
• Develops policy and procedures to ensure benefit plans and claim standards are properly administered
• Monitors claim staff for compliance
• Influences department morale by setting achievable goals and fostering teamwork
• Establishes annual goals for staff that align with organization strategies
• Acts as a liaison for claims on various projects and system implementation testing

Required qualifications

• Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims
• Strong leadership and team management skills
• Ability to analyze claims data and make informed decisions
• Previous experience in claims processing or a related field, including supervisory experience
• Understands health insurance benefit administration in a Self-Funded environment
• Ability to read and understand various forms, documentation, files, and information
• At least 3 years of experience with self-funded health care plans and processing in a TPA environment
• At least 3 years of experience supervising a claims team
• Prior experience with a highly automated and integrated claim adjudication system
• Experience working with HealthRules Payer

Nice to have

• Past Training Experience
• Experience working at TPA
• Experience with self-funded plans

About the company

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. The company is headquartered in Buffalo, NY.