Claims Supervisor

Summary

Join Brighton Health Plan Solutions, LLC as a Claims Supervisor and lead a team of 12-20 Claim Examiners and Claim Team Leads. You will provide coaching, mentoring, and training while ensuring quality customer service. This role requires identifying opportunities to enhance workflows and increase team productivity. You will provide ongoing feedback, address performance issues, and collaborate with other departments. The Claims Supervisor makes independent decisions, prioritizes workload, and contributes to corporate goals. This position offers the chance to significantly impact the efficiency and success of the claims team.

Requirements

• 3+ years of experience in supervisory or leadership role
• Advanced knowledge of Excel
• Strong knowledge of contracts, medical terminology, and claims processing and procedures
• 5+ years of advanced claims adjudication experience, including facility, professional, and ancillary claims
• Excellent written and oral communication, interpersonal, and negotiation skills with the ability to prioritize tasks
• Problem-solving and organizational skills, ability to prioritize and multitask effectively
• Ability to establish and maintain positive work relationships with clients, coworkers, members, providers, and customers
• Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances

Responsibilities

• Effectively supervise 12-20 direct reports—consisting of claim examiners and claim team leaders, including remote employees
• Provide full-time technical support to Claims, internal departments, vendors, and customers
• Distribute daily work to the team and monitor aging inventory resolution
• Train new hires, vendors, and existing staff as needed
• Research and respond to escalated issues and pertinent information on claims requiring adjudication
• Review and process High Dollar claims and conduct quality reviews of claims and logic changes/updates
• Assist Customer Service in resolving customer questions and concerns
• Researching and resolving client inquiries and performing client-requested claim adjustments
• Coach, counsel, and mentor employees to meet quality, claims accuracy, and productivity standards, and address performance and disciplinary issues
• Conduct audits as needed and manage payroll, timesheets, employee schedules, and time off requests
• Perform quarterly Performance Evaluations and consistently host individual and team meetings with direct reports

Preferred Qualifications

Bachelor's Degree or comparable experience in the healthcare field preferred