POSITION SUMMARY
The Supervisor, Claim Operations will help the Management team monitor the daily work within the Claims department. The Supervisor, Claim Operations, is responsible for the training and development of new hires and existing department staff. The Supervisor, Claim Operations will plan and maintain workflows, procedures and policies that enable and encourage the optimum performance of the team.
ESSENTIAL FUNCTIONS
- Lead employees to meet Allied’s expectations for productivity, quality, and goal accomplishment
- Assist with the development and implementation of detailed workflows to improve the consistency and accuracy of the staff
- Adhere to and apply all applicable privacy and security laws, including HIPAA, HITECH and any regulations promulgated thereto
- Assist other departments on questions related to the payment of claims
- Monitor all reports including the Workflow Manager, Pended claims, Suspended claims, Inventory listings, Audits and Automation to ensure that all workflows are followed
- Attend continuing education classes as required, including HIPAA training
- Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent
- Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed
- Actively engage, coach, counsel and provide timely, and constructive performance feedback
- Other related duties as assigned
EDUCATION
- High school diploma required, Bachelor’s degree or equivalent work experience in the healthcare industry required preferred.
EXPERIENCE AND SKILLS
- 3 -5 years of experience in healthcare and/or insurance industry preferred.
- 1-3 years prior supervisory experience preferred.
- All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology.
- Applicants must demonstrate the ability to supervise tasks and contribute to the Team atmosphere and concept.
- Applicants must have a minimum of 5 years of medical claims analysis and adjudication experience (including dental and vision claims analysis).
- Prior experience in management and training is preferred but not required.
POSITION COMPETENCIES
- Accountability
- Coaching and Feedback
- Collaboration
- Customer Focus
- Decision Making
- Execution Management
- People Leadership
PHYSICAL DEMANDS
- This is a standard desk role that requires extended periods of sitting and computer work
WORK ENVIRONMENT:
- Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
Skills Required
- High school diploma
- Bachelor's degree or equivalent healthcare work experience
- Minimum 5 years medical claims analysis and adjudication experience including dental and vision
- 3-5 years experience in healthcare and/or insurance industry
- 1-3 years prior supervisory experience
- Strong analytical skills and knowledge of computer systems
- Knowledge of CPT and ICD-9 coding terminology
- Ability to supervise tasks and contribute to a team atmosphere
- Familiarity with HIPAA and HITECH privacy/security requirements
- Prior experience in management and training
What We Do
Allied is a national healthcare solutions company that works with organizations who choose to take control of their healthcare. We customize employer self-insurance benefits to align with individual choice and organizational need while integrating medical management innovations and cost-control strategies. With healthcare designed for people, employers never have to choose between price and the best-fit insurance products to protect employees and their families. Allied’s philosophy is to create a culture of health for our member organizations and their employees beyond simple, medical health. We integrate administrative services, care solutions and analytics to achieve better clinical, behavioral and social patient outcomes. Allied’s programs and benefit services are designed and structured to infuse value on every front – for employers and HR departments, for plan members and their families, for healthcare providers, and for us. We’re in this together, committed to your future.
