Job Description

Job Description

The Claim Supervisor is responsible for the oversight and management of health claims processing  and will have direct management of a team of claim examiners and/or support roles. The team is responsible for the accurate processing of health care claims on behalf of the employer plan and members benefits and will set and monitor claims examiner productivity goals and claim quality metrics.. Key to the success of this position includes: attention to detail, strong organizational skills and a good understanding of Microsoft Office tools

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Role and Responsibilities:                                                               

• Managing Daily Team Operations - Managing a team of up to 20-30 resources
• Team mentoring & coaching individual associates who may fall below desired performance     
• Handle escalations on process issues that cannot be resolved by agents
• Monitoring and ensuring closure of daily/weekly and monthly deliverables - Managing SLA, Daily Reporting, Agent's leave planning
• Monitor random cases to improve quality, minimizing errors and track operative performance
• Assign tasks, supervise, mentor and complete timely performance evaluations.
• Conduct remote and side by side monitoring of member processing to ensure quality assurance standards are met.
• Consistently communicate changes such as policies, procedural and overall performance as a team and one-on-one.
• Ensure required training courses are completed timely.

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Qualifications

• 4-5 years of Team Lead or Supervisory experience with 2/3 years’ experience with claims processing
• Demonstrate strong work ethics by maintaining confidentiality of information.
• Requires specialized knowledge where problems, assignments and / or duties are difficult but related.
• Must be able to think and work independently, but structured by broad principles and / or procedures.
• High aptitude for working with numbers.
• Must work well under pressure and make decisions quickly
• Have excellent interpersonal and communication skills and ability to address conflict proactively
• High School Diploma or higher (will be verified and you will need to provide documentation during on-boarding process)
• Comfortable working from the Tampa office as required

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• Stakeholder Interaction & Management 

  • Coordinate with internal and external stakeholders to ensure compliance and quality in the delivery for accounts
  • Interact and engage with the client manager to communicate and update progress against account plan, project delivery etc.
  • Participate in monthly review meetings with Account Delivery leadership  updating them on the status and progress of the account
  • Work with quality team to ensure the quality improvements as per the delivery standards of the contract
  • Provide timely assistance in case of an escalation and support resolution of escalations/ issues 

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• Effective Team Management

• Resourcing

  • Hire adequate and right resources for the team 
• Talent Management
  • Ensure adequate onboarding and training for the team members to enhance capability & effectiveness
  • Build an internal talent pool and ensure their career progression within the organization
  • Manage team attrition 
  • Drive diversity in leadership positions

• Performance Management

  • Set goals for the team, conduct timely performance reviews and provide constructive feedback to own direct reports
  • Ensure that the Performance Nxt is followed for the entire team

• Employee Satisfaction and Engagement

  • Lead and drive engagement initiatives for the team
  • Track team satisfaction scores and identify initiatives to build engagement within the team