Claims Supervisor - Portland, United States - Cambia Health Solutions, Inc

Description

This role supports members, providers and various internal departments by mentoring staff, monitoring workflow, maintaining performance measures and ensuring timely and quality claims processing while adhering to State, Federal and company guidelines.

• Assigns and prioritizes work, sets goals and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings.
• Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and is in compliance with medical policy and guidelines.
• Assists in development of productivity and quality standards. May conduct or participate in compliance audits and report audit findings. Identifies and implements process improvements as needed. Ensures full participation of their team in MTM, URAC and all other compliance requirements.
• Acts as a resource for staff and others. Appropriately escalates issues and partners with other departments to resolve issues and remove barriers.
• Participates in the selection process, provides on-going coaching and performance management and is responsible for writing performance reviews. Ensures new hires complete necessary training. Assesses training needs and plays an active role in development of staff.
• Facilitates maintenance on reference manuals, work procedures and procedural guidelines.
• Completes special projects as assigned, to include, leading division projects and/or implementing process improvement projects. May lead projects where tracking and analyzing data and presenting to departmental leadership is required.
• Participates on project teams by recommending solutions and translating business requirements, schedules and communications.
• Oversees scheduling, reporting to management, meeting facilitation, issue resolution, and other support services as well as execution of the plans.
• Ensures claims processing is managed accurately and timely according to company timelines.

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
• Ability to effectively develop, train and lead a team (including employees who may be in multiple locations or work remotely) and assist in the development of productivity, quality and service standards.
• Demonstrated analytical skills, ability to identify problems, trends; develop solutions and implement a course of action.
• Ability to communicate effectively, verbally and in writing with all levels of the organization; to include strong customer service skills and the ability to work with internal and external groups or parties.
• Knowledge of insurance industry and related regulations and mandates.
• Ability to organize, plan and prioritize assignments within multiple projects.
• Ability to participate in and at times manage well-defined projects with minimal guidance.
• Experience working in a high volume claims processing center, with proven ability to effectively manage performance while creating an environment for service excellence.
• Working knowledge of medical terminology and/or claims coding.

Supervisor of Member Services Claims would have a Bachelor's degree and 3 years of experience related to claims processing, preferably in the healthcare industry and demonstrated leadership/supervisory experience, or the equivalent combination of education and experience.

5-20

• Duties performed in an office environment.
• Travel may be required, either locally or out of state.

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