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Supervisor - Benefit Plan Configuration

3 months ago

King of Prussia, United States Worldwide Insurance Services Full time
Job DescriptionJob DescriptionSummary: The Supervisor – Benefit Plan Configuration supervises a team of Benefit Configuration Specialists and Actisure Policy Specialists who are responsible for the validation, communication, documentation, set-up, scheduling, and troubleshooting of multilevel benefit plans on the claims systems. The Supervisor will provide leadership and training to the Specialists and the Quality Analyst on assigned projects. The Supervisor will identify and implement processes to strengthen and streamline build procedures. The Supervisor will monitor staff quality and productivity to ensure the accuracy and timeliness of group transactions, claims system configuration, ancillary system setup, and/or report processing for all new/renewal benefit plans. The supervisor will assist management in creating an environment of highly engaged, motivated, high-performance teams.

Responsibilities:

  • Daily management of workflow for new/renewal benefit plans as submitted by Client Management/Sales.
  • Provide guidance and support to all team members in the set-up & system auditing of new/renewal benefit plans.
  • Review, resolve & respond to inquiries as they pertain to the claims processing systems and the benefit plan coding and configuration.
  • Interaction with multiple internal departments and the claim system vendor for the development and implementation of new processes to maximize system capabilities.
  • Assist in the review of system enhancement requests submitted to the claims system vendor, and associated vendor documentation.
  • Assess/update system configuration to support new processes or new product development.
  • Proactively conduct audits to confirm accuracy of set up. Minimize errors through effective research, analysis, solution development, configuration, testing, communications, and documentation of reactive and proactive corrective actions.
  • Assist in the development, review, and update of procedural documentation associated with claim system / benefit configuration setup procedures.
  • Assist in the development, documentation, and execution of builds for benefit policies used in testing and production including, but not limited to trouble tickets, software releases and fixes, enhancements, and new product development.
  • Document procedures and guidelines used in providing coaching, training, and mentoring to Specialists.
  • Follow regulations and company rules and policies as outlined in the Employee Manual.
  • Other duties as assigned.

Requirements:

  • Undergraduate degree preferred and/or equivalent work experience.
  • Five to seven years in an Operations function, such as Claims, Audit, Customer Service, or Account/Client Management.
  • Team Lead/Supervisory experience in the health insurance industry is desirable.
  • Ability to coach, train, and motivate employees – as well as evaluate and have input on staff performance for performance appraisals.
  • Excellent verbal and written communication skills needed to effectively relate with internal departments and vendors for any issues identified or enhancements needed.
  • Ability to navigate and leverage salesforce, benefit documents, reporting tools, and claims adjudication software for analytics and root-cause analysis.
  • Intermediate proficiency in MS Office products. Proficient/advanced Excel skills a plus.
  • Advanced proficiency with claims software to include experience with benefit configuration for Medical Plan Applications, such as policies, ICD 9/10 & CPT code supplemental tables, deductibles, co-insurance, co-pays, limits, provider service agreements, and claims processing hierarchy. Familiarity with the Actisure a plus.
  • Ability to provide consultative guidance and to document business requirements directly with business stakeholders.
  • Ability to see the “big picture,” leading a team to make strong and reliable recommendations for improving operational performance, increasing customer satisfaction, and employee satisfaction.
  • Experience in project management, operational/process analysis, design and improvement a plus.
  • Ability to manage multiple assignments simultaneously while maintaining quality standards and meeting assigned deadlines.
  • Ability to make decisions and support them with documentation.
  • Must speak and write fluent English.
  • Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).

Working Conditions:

  • Flexibility to work in an office and/or at-home, remote office environment.
  • Schedule flexibility is occasionally necessary in this position. Individual may be required to perform certain business critical job functions outside of normal working hours.
  • Physical Demands: Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.

    The starting pay for this role is $57,411 to $73,199 based on skill level and experience in a similar role.

This job description reflects management’s assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.