Supervisor (Claims), IDR
As a Claims Supervisor, you will review claims and supporting documentation from providers and health plans to make accurate eligibility determinations for disputed claims. You will oversee the workflow of assigned Claims Specialists, ensure quality and productivity standards are met, and provide training on intake, eligibility review, and the handling of single, bundled, and batched cases. Success in this role requires strong attention to detail, sound judgment, a collaborative approach, and a commitment to delivering excellent customer service within the Federal IDR Process and other state and federal programs.
Duties include, but are not limited to:
- Review assigned case documentation and determine whether disputes qualify for the Federal IDR process.
- Manage the daily operations of assigned Claims Specialist teams.
- Track team productivity, conduct performance evaluations, provide coaching and feedback, and take corrective action when needed.
- Oversee employee performance metrics, timesheet approvals, time-off requests, reporting requirements, and new hire onboarding activities.
- Ensure employees meet quality standards and delivery deadlines, resolve production issues, and escalate concerns to senior management as needed.
- Manage workflow, assign responsibilities, and hold team members accountable for results.
- Set performance goals and deadlines aligned with company objectives and report variances to senior management.
- Maintain accurate timekeeping and personnel records.
- Train new employees and provide ongoing training on intake and eligibility processes.
- Lead team huddles and project meetings, identify recurring issues, and implement solutions.
- Work directly with customers to resolve concerns, discuss case scenarios, and communicate process updates and directives.
- Complete tasks assigned by direct manager, including case intake, eligibility review, case follow-up, and other projects as needed.
This is an in-office position based in IPRO's headquarter office located in Jericho, NY
QUALIFICATIONS:
- Motivate employees by resolving issues and making sound decisions
- Serve as a conduit of communication between employees and senior managers
- Ability to problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
- Strong ability to motivate team members
- Detail oriented mindset, excellent organizational skills, and ability to adhere to deadlines
- Ability to supervise, manage and coordinate team members to positive outcomes.
- Excellent written and verbal skills.
- Ability to work independently with little supervision.
- Ability and desire to be flexible, innovative, and creative while multi-tasking.
- Ability to meet deadlines in a time sensitive environment.
- Familiarity with CMS Federal IDR Process billing rules and regulations.
EDUCATION & EXPERIENCE:
- Bachelor’s or advanced degree in healthcare, business, or related field, required.
- Two (2) years’ experience in medical billing, auditing or claims review, appeals or dispute resolution in healthcare or insurance industries, regulatory, required.
- One (1) year experience working in Independent Dispute Resolution, required.
The salary range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The salary range for this position is $82,500.00 to $86,500.00. Actual salary and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.
The salary range listed does not include other forms of compensation or benefits.
IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status.
Skills Required
- Bachelor's or advanced degree in healthcare, business, or a related field
- Two years of experience in medical billing, auditing, claims review, appeals, or dispute resolution within healthcare or insurance industries
- One year of experience working in Independent Dispute Resolution
- Familiarity with CMS Federal IDR Process billing rules and regulations
- Ability to supervise, manage, coordinate, motivate, and hold team members accountable
- Strong problem-solving, collaboration, organizational, and attention-to-detail skills
- Excellent written and verbal communication skills
- Ability to work independently with little supervision
- Ability to multitask, meet deadlines, and work flexibly in a time-sensitive environment
What We Do
IPRO is a non-profit organization that works with government agencies, providers and patients to implement innovative programs that bring policy ideas to life. For more than 40 years we’ve made creative use of clinical expertise, emerging technology, and data solutions to make the healthcare system work better. IPRO holds contracts with federal, state, and local government agencies, as well as private-sector clients, in more than 34 states and the District of Columbia. IPRO is headquartered in Jericho, NY and also has offices in Albany, NY; Hamilton, NJ; and Beachwood, OH. IPRO’s staff of more than 300 professionals includes physicians, registered nurses, mental health professionals, epidemiologists, biostatisticians, data analysts, medical record reviewers, health policy experts, pharmacists, coding professionals, claims analysts, auditors, programmers, systems analysts, web technology experts, and healthcare communications specialists. IPRO also retains a network of more than 300 board-certified physician consultants.



