Claims Supervisor - Management Ancillary Support (CMAS)

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 Previous experience in claims processing or 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 High School diploma or GED required. Bachelor’s degree or equivalent work experience. 5 years or more experience with healthcare claims administration, self-funded preferred Experience leading and delegating tasks to multiple direct reports Excellent verbal and written communication skills Proven organizational, rational reasoning, information examination, and problem-solving skills Proficient experience in MS Word, Excel, Outlook, and PowerPoint Prior experience with a highly automated and integrated claim adjudication system (El Dorado-Javelina and/or Health Rules Payer experience preferred but not required) Experience with member appeals, recovery processes, including NSA, subrogation and overpayment process, member, and/or client escalations (preferred) Ability to understand how and do thorough research, comfortable interviewing internal expertise and applying the 5 W’s and/or other tools to complete root cause analysis (preferred) Ability to assimilate quickly to the organization or department’s culture and speak in the voice of the brand (preferred) Ability to take complex issues and break them down so that it can be understood by others (preferred) Strong knowledge of benefit plans, policies, and procedures, understanding of medical terminology (preferred) Strong technical and analytical skills (preferred)

Oversee and manage claim processing functions Direct management of a claims processing team Set productivity benchmarks and enforce quality standards Drive continuous improvement in claims processing Collaborate with internal and external partners to resolve issues Ensure standard processes are established and policies are enforced Demonstrate knowledge of benefit administration for self-funded healthcare plans Ensure claims are processed and paid per benefit plans and agreements Manage claim inventory against SLAs Educate and mentor claims staff Provide reports on claim inventory, production, and quality Develop and implement policies and procedures for claims administration Influence department morale and foster teamwork Establish annual goals for staff and provide feedback Serve as liaison for CMAS team on projects and initiatives