Claims Supervisor
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Job Description
Claims Supervisor leading claims processing and quality for Centivo’s self-funded employer healthcare plans. Managing teams, SLAs, reporting, and claims system improvements.
Responsibilities:
- Lead a team of Claims Processors
- Ensure accurate and efficient claims processing for employer-sponsored health plans
- Set productivity benchmarks and enforce quality standards
- Drive continuous improvement
- Collaborate with support teams to manage backlog and turnaround times
- Work with Quality/Training and System Configuration teams to standardize processes and resolve issues
- Oversee appeals, subrogation, and overpayment/refunds as needed
- Ensure claims are processed and paid according to benefit plans, pricing agreements, and required authorizations
- Manage claims inventory against standard service level agreements
- Educate and mentor claims staff
- Establish performance plans and provide coaching and mentoring
- Report claim inventory, production, turnaround lag, and quality metrics to department leaders
- Develop and monitor policies and procedures for benefit plan and claims administration
- Influence department morale, foster teamwork, and involve the team in solutions
- Establish annual staff goals and provide performance feedback
- Serve as claims liaison for projects, initiatives, testing, system implementations, and upgrades
- Perform other essential duties
Requirements:
- 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
- Understanding of 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
- Candidates must be authorized to work in the United States for any employer
- Centivo does not sponsor work authorization visas
Benefits:
- Equity
- Bonus
- Ability to work from home
- Remote work opportunity for candidates outside the Buffalo area
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