Claims Supervisor

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. Understanding of health insurance benefits administration in a self-funded environment. Thorough understanding of insurance policies, claims handling processes, and legal requirements. Strong leadership and team management skills. Ability to analyze claims data and make informed decisions.

Ensures that 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 (SLA’s). Educates and mentors claims staff to ensure proper application of client benefit plans. Provides reports to department leaders on claim inventory, production, and quality metrics. Develops policy and procedures to ensure benefit plans and claim standards are properly administered. Accountable for positively influencing the morale of the department employees. Responsible to establish annual goals for staff. Is a liaison for the claims on various projects and/or initiatives.