- Pasadena, CA
What you'll be doing
- The claims supervisor under the direction of the claims manager would be responsible for promoting, implementing and overseeing the day-to-day operations involved in the claims processing for a staff size of approximately 14 to 20 people. Allocate assignments/projects to team members based upon claims production and medical review processes. Assist with production activities to ensure timely and accurate adjudication of claims in accordance with department procedures. Oversee claims production, by using production reports and daily aging inventory reports. Create and foster a well-organized department through team meetings, training, updates in company policies and workflows. Perform weekly claim audits of staff to ensure department claims processing standards are being met. Conduct bi-weekly one-on-one team meetings to offer guidance and ensure that standards and policies are being met. Create and foster a well-organized department through team meetings, training, updates in company policies and workflows. Provide leadership and coaching to all claims staff. Conduct annual performance evaluations, and address any concerns arising regarding workflow. Responsible for team communication and conduct team meetings.
What your background should be
- Preferably a candidate with at least 5 years of proven supervisory experience in claims processing/operations and several years of processing experience in PPO medical claims. Strong knowledge of all claims types and methodologies. Experience with managed care/PPO/HMO/Medicare claims processing standards. Working knowledge of various provider reimbursement methodologies, Medicare (CMS) regulations, coordination of benefits, health plan division of financial responsibility (DOFR) and DMHC regulations.
Required Schooling / Training
- High school diploma required. BA preferred.
Who is the client company
- Concern about healthcare services.
- If you are interested in this position, send your resume to firstname.lastname@example.org