To serve as a front-line supervisor by managing and directing the activities of a team of Claims Examiners and Claims Benefits Specialists. To handle claims processing concerns and issues requiring a high degree of appropriate knowledge, creativity, research, and communication with internal and external resources to achieve timely resolution. To ensure resources are utilized efficiently, in accordance with Claims Administration objectives that consistently promotes internal and external customer quality and satisfaction. Assists the Manager of the Claims Department by monitoring the daily workflow for team members in reference to claim volume, receipts, and processing. To act as a communication conduit between the Claims Examiners, Claims Benefits Specialists, and management.
Proactively identifies and solves problems with timely resolution of complex issues referred by Claims Examiners and Claims Benefits Specialists. Identifies the most appropriate course of action for problem resolution and effectively communicates the plans to those impacted. These issues frequently require research, collaboration with other departments, communications with external resources, and response creation.
Provides daily management support to Claims Examiners and Claims Benefits Specialists. Participates in new-hire interviews and make recommendations for candidate selection.
Regularly monitors Claims Examiners and Claims Benefits Specialists using the weekly productivity log to ensure Claims Examiners and Claims Benefits Specialists are performing within Claims Administration’s production goals and identify any individual coaching or group training for long-term performance improvement and teamwork. Identify opportunities and recognize positive behaviors of Claims Examiners and Claims Benefits Specialists.
Monitors available resources, system reports to facilitate the day-to-day operations to ensure that Claims Examiners and Claims Benefits Specialists are productive and have the necessary tools and information to perform their job. Responds to internal system trouble notifications and coordinates the involvement of other departments to facilitate problem resolution.
Maintains visibility to Claims Examiners and Claims Benefits Specialists. Walks around periodically to perform live monitoring of Claims Examiners and Claims Benefits Specialists and provides support to those needing assistance.
Skills:
Knowledge of the health plan’s operations, claim and eligibility systems, ICD-9, CPT/HCPCS coding methodologies (and their successors), detailed claims processing experience, Medicaid state regulations and rules.
The ability to work well in a team environment and adopt a customer service perspective; excellent verbal and written communication skills; ability to interface with all levels of management, be detail oriented with the ability to multitask and display leadership skills.
Utilize Microsoft Office products for auditing, presentations, and communication.
Education: Required: H.S. Diploma or GED Required: 5 years claims processing experience
Numbers & Facts
Location
Bellaire, TX
Skills
Auditingunmatched
Claims Managementunmatched
Claims Processingunmatched
Coachingunmatched
Communication Skillsunmatched
Compensation and Benefitsunmatched
Current Procedural Terminology (CPT)unmatched
Customer Acquisitionunmatched
Customer Satisfactionunmatched
Customer Support/Serviceunmatched
Detail Orientedunmatched
Health Planunmatched
Healthcare Common Procedure Coding System (HCPCS)unmatched
ICD-9unmatched
Identify Issuesunmatched
Leadershipunmatched
Medicaidunmatched
Microsoft Officeunmatched
Microsoft Product Familyunmatched
Multitaskingunmatched
Operations Planningunmatched
Performance Managementunmatched
Presentation/Verbal Skillsunmatched
Problem Solving Skillsunmatched
State Laws and Regulationsunmatched
Team Playerunmatched
Time Managementunmatched
Writing Skillsunmatched
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