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Claims Supervisor

4 months ago

Chicago, United States Local 4 SEIU Health & Welfare Fund Full time
Job DescriptionJob DescriptionDescription:

JOB TITLE: Claims Supervisor

REPORTS TO: Medical Benefits & Claims Manager

DEPARTMENT: Medical Claims

POSITION TYPE: Salaried, Exempt

BARGAINING UNIT: Non-Bargaining Unit


SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with the delivery of health and pension benefits. Our employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance with one another to carry out our shared mission and common agreements for those we serve.


Position Summary:

The Claims Supervisor is responsible for overseeing the medical claims processing operations of the Claims staff. The Claims Supervisor leads the claims staff by effectively applying technical competencies and leadership strategies to oversee employee supervision and ensure the team meets all departmental policies, procedures, and performance goals of the medical claims processing operations. The work will focus primarily on effective supervision of staff, end-to-end claims processing automation and optimization, and claims system configuration. The Claims Supervisor will coordinate initiatives with other department leaders to ensure member and provider service expectations are met. The Claims Supervisor needs a high proficiency in working both collaboratively and independently to ensure members and providers are being serviced timely and accurately.

The Claims Supervisor will maintain a high standard of performance while identifying problems, developing solutions and process improvements, and resolving issues with direct reports and other stakeholders. This position provides support and reports directly to the Claims Manager and will work collaboratively with other leadership.


Key Duties and Responsibilities:

The Claims Supervisor will be responsible for the following:

· Manages staff, demonstrating leadership qualities consistent with management values and mission.

· Effectively manage staff under a Collective Bargaining Agreement (CBA).

· Reviews and approves staff time off requests and payroll processing.

· Develops and coaches staff through direct feedback, performance management, goal setting, and training and development, and effective employee relations.

· Cultivates an environment of high morale, empowerment, and continuous improvement, innovation, and initiative.

· Oversees immediate direct reports in key functional areas including claims processing, appeals, quality metrics, configuration, and interdepartmental processes and procedures.

· Establishes and monitors key performance indicators (KPIs) to track trends and progress of department goals and objectives; and the quality of work performed by employees in pursuit of goals and objectives.

· Communicates professionally with leadership team, staff, members, medical providers, and external partners as directed to develop effective working relationships.

· Establishes, assigns, distributes, and monitors quality and quantity metrics of work while ensuring employees are held accountable for consistently meeting quality and production standards.

· Ensures compliance and regulatory guidelines are adhered to, including but not limited to PPACA, No Surprises Act, Transparency Rules, DOL, ERISA, HIPPA, and other required guidelines.

· Oversees the maintenance of plan documents including but not limited to plan descriptions, summary of material modifications, and summary of benefits and coverage.

· Ensures the active operation of benefits administration system(s) that fully supports the functions of the department.

· Identifies issues and problems, develops solutions, and prepares recommendations, including development of policies and procedures.

· Configure contract terms within the benefit administration system to ensure accurate payments are processed and reflected in the participant and provider explanation of benefits (EOBs).

· Meet weekly with staff to build relationships, review operational processes, issue directives, and provide performance progress.

· Prepare and conduct staff annual performance reviews.

· Create and document policy and procedures for consistency in claims processing operations.

· Maintains knowledge of all health plans and department operations.

· Triage and or resolve escalated inquiries from plan participants, unions, medical providers and or billers.

· Performs other similar related duties and special projects as required.

· Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for issues, as well as identify potential process improvements.

· Create one-on-one (1:1) agendas for all meetings using the Purpose, Outcome and Process (POP) Model and keeping thorough notes for each meeting.


Privacy and Security Responsibilities:

This position requires employee to handle Personal Identifiable Information (PII) and potentially Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officer.


Requirements:

Education Requirements:

· Bachelor’s degree in Business Management, Healthcare Administration, or other relevant fields.

· An equivalent combination of education, certification, training and or work experience may be used to meet the minimum education qualifications.


Job Requirements:

· Minimum of seven (7) years related field experience, preferably in medical insurance, medical claims operations, or third-party administrator environment.

· Experience in provider relations and analyzing provider contracts.

· Minimum of three (3) years related supervisory experience, preferably in medical claims operations, medical provider billing, or third-party administrator environment.

· Proven ability to lead, hold accountable and motivate a team to carry out the organizational mission and department objectives, understanding that attitude and behavior matter for a healthy and successful team.

· Excellent oral, written, and non-verbal communication and interpersonal skills with the ability to actively listen and share insight.

· Strong decision-making and organizational skills, with the ability to optimize the use of all available resources to deliver to multiple priorities.

· Experience specifically with medical claim and billing analysis to report department statistics and make meaning of data to inform recommendations and decisions.

· Exceptional analytical and problem resolution skills with attention to detail and accuracy; ability to exercise independent and sound judgment.

· Working knowledge of medical benefit and claims system configuration.

· Knowledge and understanding of the health care industry, including in-depth medical claim processing, subrogation, pharmacy benefits, ICD-10 Diagnosis Codes, CPT Procedures Coding, HCPC Codes, HCFA 1500, and UB-02 claim forms.

· Experience with desktop computers, laptop computers, printers, copiers, scanners, fax, and other office equipment.

· Proficient skills, intermediate to expert level, in Microsoft Office Suite (Word, Excel, Access, Power Point, Visio, and Outlook)

· Ability to organize, prioritize tasks, and meet deadlines.

· Ability to demonstrate teamwork and work independently.

· Exercise clear and concise judgement.

· Ability and willingness to assist in special projects and handle multiple tasks.


Preferred Skills:

· Prior multi-employer and Taft-Hartley trust fund experience strongly preferred.

· Master’s Degree in Business Management, Healthcare Administration, or other relevant fields.

· Management of a hybrid workforce, with in-person and remote work expectations.

· Working knowledge of the basys benefits administration system.

· Experience with project management software, such as Smart Sheet.

· Experience with virtual conference software (Teams and Zoom).

· Internal and external awareness of social movements, labor movements, and political issues that impact healthcare and the organization.


Career Development & Continuing Education Opportunities: Yes

Benefits:

SEIU Healthcare IL Benefit Funds offers a comprehensive health benefit (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan.

Diversity creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.