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Supervisor, Claims Administration

at HMSA

Posted: 10/2/2019
Job Reference #: 5000499743806
Keywords: supervisor, manager

Job Description

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

This employee manages one or more units responsible for the processing, review and adjudication of provider and/or member claims. Provides oversight of the day-to-day responsibilities and performance of assigned staff, mentors, coaches and provides direction. Manages claims Inventory and related functions. Ensures department goals, objectives, quality and performance measures are met. This results-oriented supervisor will develop the required business knowledge to effectively represent business area(s) of oversight by providing business requirements for program, benefit and/or system changes.

Minimum Qualifications

  • Bachelor's degree and two (2) years of related work experience; or an equivalent combination of education and related work experience.
  • 1 year experience in a leadership role or with general management or supervisory responsibilities.
  • May occasionally be required to attend conferences and seminars on the mainland as required by HMSA's business needs.
  • May be required to travel to HMSA business locations to support department staff.
  • Excellent verbal and written communication skills,
  • Excellent coaching skills
  • Excellent interpersonal and collaboration skills.
  • Good working knowledge of Microsoft Office applications

Duties and Responsibilities

1. Daily Operations

a. Ensures program compliance, accuracy and claims processing timeliness for all contracted programs (i.e. Federal Plan 87, FEP, State Health Fund, Akamai Advantage ( MAPD), and QUEST Integration (Medicaid).

b. Monitor inventory and related reports (i.e. High Cost, volume, age) to ensure performance measures are met.

c. Drive cross functional collaboration across all departments to develop solutions that improve performance and enhance the customer experience.

d. Represent area(s) of responsibility by participating in group discussions and projects. Ensures development and implementation of program changes that impact quality and unit performance that include but are not limited to providing program requirements for system changes.

e. Identify and raise issues and concern to management in a timely manner (high cost claims, government programs, contractual compliance and financial penalties.

 

2. Staff Oversight

a. With minimal direction, selects, trains, develops and organizes examiners and other support staff to use group and individual capabilities to maximize productivity and meet the unit's business objectives.

b. Manage day-to-day responsibilities of staff to include but are not limited to the appropriate application of benefit and administrative policies through claims processing accuracy.

c. Provides feedback and coaching (helping individuals to solve problems/issues on their own) to staff including interim and year-end performance reviews.

 

3. Financial Oversight

a. With some guidance and support from manager develop unit business plan and budget.

b. Manage unit expenses to ensure it is within approved budget.

c. Monitor and minimize claims interest payments.

 

4. Other duties/functions:

a. Attends and completes HMSA training classes as assigned.

b. Other duties as assigned.