Claims Operations Supervisor

Minnetonka, MN

Humera is seeking TWO talented and experienced leaders with healthcare claims experience to join our client's teams as Claims Operations Supervisors in Minnetonka, MN. This role will be responsible for day-to-day leadership of individuals in various claim support functions, ensuring high-level quality and productivity in processing. The Claims Operations Supervisor is responsible for the timely and accurate adjudication and payment of claims or adjustments initiated by internal and external customers. They will also provide coaching and mentoring to team members or peers.

These two positions are Contract to Hire opportunities! Though the positions start remote, we are only considering candidates local to the Twin Cities, as they will be returning to work on site (date to be determined).

KEY ACCOUNTABILITIES:
Leadership & Communication

  • Provides day-to-day work direction and assignment of claims
  • Leads by example - understands, adheres to and is a resource to others regarding departmental policies and procedures
  • Provides regular performance feedback and coaching
  • Serves as claims processing expert for other department personnel
  • Facilitates regular team meetings; communicates information in a timely manner
  • Respects confidentiality and closely monitors adherence to PHI, PCI and Clean Desk policies
  • Approves time off and timesheets
  • Assesses individual and team performance; identifies and remediates gaps
  • Serves as proxy for Claims Manager by supporting day to day operations, attending meetings, being involved in projects and sharing subject matter expertise
Claims Processing Approval
  • Based on established dollar thresholds, reviews and approves claim payments that exceed processor authority
  • Reviews claims to ensure proper information to complete processing
  • Monitors and promotes on-going analysis of trends; alerts Claim Operations leadership to anomalies
  • Monitors claim receipts and manages daily claim inventory to ensure service goals are consistently met
Reporting, Monitoring, Reconciliation
  • In partnership with their manager, monitors incoming EDI volumes to insure clearinghouse and network SLAs are adhered to so as to avoid unnecessary delays in claim adjudication
  • Supports daily reporting/tracking and work distribution
  • Understands key metrics within the claim operation and at times may be asked to create/complete related reports that serve as controls to insure operational performance remains consistently high
  • Initiates, reconciles and reports claims payment reconciliation; authorizes claim payment file; initiates investigation related to discrepancies
Claims Systems SME
  • Participates in and leads projects related to automation improvements or software upgrade testing. Approves software upgrade approval upon review of testing results
  • Participates in and serves as SME expert in meetings with IT, Finance, Compliance, Configuration, Training Provider Services
  • Serves as Manager proxy in the absence of the Manager

MINIMUM QUALIFICATIONS/REQUIREMENTS:

  • Education Requirements: Bachelor’s Degree or equivalent work experience related directly to medical claims processing, finance, or related fields experience
  • Field Experience Requirements: 3 years of complex direct medical claims processing experience with 2 or more years as a Lead/Supervisor in a medical claims environment
Specific types of experience or skills required:
  • Demonstrated flexibility to adapt to changes in procedures and job assignments
  • Proven ability to lead/supervise a team and independently seek solutions to problems
  • Excellent prioritization skills in order to schedule work to meet deadlines
  • Excellent verbal and written communication skills
  • Well-developed, metrics based analytical skills
  • Ability to evaluate and determine the appropriate course of action (problem solving/leadership skills)
  • Demonstrated ability to mentor, coach and assist others
Number of direct reports and titles:
  • 11 - 20 Claims Processors, Specialists, Coders, and Claims Operations Analysts
BUDGETARY/FISCAL RESPONSIBILITIES:
  • Daily reconciliation of claim files of $5m in billed charges and reconciliation of payment cycle of $4m three times per week
  • Daily approval of claims greater than
  • $10k in allowed charges.

Schedule

    Monday - Friday 8:00AM – 5:00PM

    Start date is Monday, May 17, 2021; mandatory training to follow

Post Date: 04.20.2021

Salary: Dependent on Qualifications

Shift: 1st

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If you would prefer to speak directly to a Humera Staffing Consultant, please call us at 612-977-1440 and reference OrderID 815233


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For more than 45 years you may have known us as Dolphin Staffing - a name synonymous with quality temporary, and direct hire employment in the Minnesota. Today we are Humera - a boutique staffing agency that specializes in the placement of the best and brightest administrative and professional talent for contract, contract to hire and direct hire opportunities. Although we have changed our name, we continue to provide flexible career opportunities across a broad range of industries and with companies large and small. We invite you to become part of our elite workforce today!

Humera Administrative and Professional Staffing is an Equal Opportunity Employer.