Supervisor, Claims
1 day ago
Title: Supervisor, Claims Department: Claims
Bargaining Unit: NBU Grade: N/A
Position Type: Exempt Hours per Week: 40
Position Summary
The Supervisor, Claims provides daily leadership and supervision to a Claims team in accordance with Company guidelines, client needs, and regulatory requirements.
"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."
Key Duties and Responsibilities
- Provides daily leadership and supervision to staff consistent with Company values and mission.
- Assigns, distributes, and monitors quality and quantity of work produced, ensuring employees are held accountable for consistently meeting quality and production requirements.
- Develops staff through performance management, goal setting, training, and effective employee relations.
- Maintains current knowledge of assigned Plan(s) and effectively applies knowledge; provides oversight of processing activities to ensure compliance.
- Optimizes workflows/processes, tools, and staff allocation to ensure efficient and cost-effective day to day operations.
- Troubleshoots customer/client service issues and assists in the successful implementation of new clients.
- Reviews and interprets new benefits plans or changes/updates to existing plans; tests benefits for validation and accuracy. Develops and distributes resource documents as needed.
- Based on location needs, may provide advanced technical review and support of claims processing.
- Provide technical review of all types of claims including large dollar and complex claims to validate benefit allowance and category.
- Investigate, evaluate, and report on advanced cases for third-party recovery including stop-loss, accident, medical malpractice, subrogation, and Worker's Compensation.
- Compiles documents, records, and data for external audits, as requested.
- Assists in the development and documentation of departmental SOP's.
- Performs other duties as assigned.
Minimum Qualifications
- High school diploma or GED.
- Four years of experience processing complex health and welfare claims in a third-party administrator.
- One year of experience in a lead or supervisory role.
- Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes.
- Thorough knowledge of claims operations to include payment of claims, interpretation of contracts, communication of benefits, etc.
- Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly.
- Highly developed sense of integrity and commitment to customer satisfaction.
- Ability to communicate clearly and professionally, both verbally and in writing.
- Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities.
- Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment.
- Computer proficiency including Microsoft Office tools and applications.
Preferred Qualifications
-
Experience working in a multi-employer or Taft-Hartley environment.
*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.
Working Conditions/Physical Effort
- Prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift up to 15 pounds at times.
Disability Accommodation
Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at recruiting@zenith-american.com, and we would be happy to assist you.
Zenith American Solutions
Real People. Real Solutions. National Reach. Local Expertise.
We are currently seeking an experienced Supervisor, Claims with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.
Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 40 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before
We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more
Internals to Apply:
If you meet the minimum qualifications and are interested in applying for the above position, please submit an application. All applications must be received by 5:00 pm on the Internal Posting Deadline listed above in order to be considered prior
-
Supervisor, Claims Processing
1 day ago
San Francisco, United States Inland Empire Health Plan Full timeOverviewWhat you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! The Supervisor, Claims Processing - Medi-Cal provides daily oversight of claims staff, business processes and inventory management. Ensures the claims team...
-
Claims Supervisor
6 months ago
San Antonio, United States 005 Southwest Business Corporation Full timeSWBC is seeking a talented individual to supervise the staff and activities involved in the accurate processing of mortgage claims to include resolving complex claims, training employees, and overseeing the department in management’s absence. This role allows one to learn, develop, or use a wide-set of skills in a face-paced environment. The person will...
-
Claims Specialist- Workers' Compensation
20 hours ago
San Francisco, United States Republic Indemnity Full timeAt Republic Indemnity, we've been helping businesses in the western U.S. manage their Workers' Compensation costs for over 50 years. Headquartered in Calabasas, California with additional offices in San Francisco and San Diego, we write workers compensation primarily in CA with significant business in AK, AZ, NV, and other western states. Whether it's...
-
Claims Specialist- Workers' Compensation
1 month ago
San Francisco, United States Republic Indemnity Full timeAt Republic Indemnity, we’ve been helping businesses in the western U.S. manage their Workers’ Compensation costs for over 50 years. Headquartered in Calabasas, California with additional offices in San Francisco and San Diego, we write workers compensation primarily in CA with significant business in AK, AZ, NV, and other western states. Whether it’s...
-
Account Claims Representative II
3 weeks ago
San Francisco, United States PMA Companies Full timeDescriptionAs a member of our Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance...
-
Senior Claims Resolution Specialist
3 hours ago
San Francisco, California, United States PMA Companies Full timeAt PMA Companies, we are seeking a skilled Senior Workers Compensation Claims Adjuster to join our claims team. As a member of our team, you will utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes.Key Responsibilities:Promptly...
-
Senior Workers Compensation Claims Adjuster
3 weeks ago
San Francisco, United States PMA Companies Full timeDescriptionAs a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal...
-
Claims Operations Manager
4 weeks ago
San Antonio, Texas, United States Usaa Full timeJob Title: Manager, Claims OperationsJob Summary: We are seeking a dedicated Manager, Claims Operations to lead a team of Auto Injury Examiners at USAA. The successful candidate will have a strong background in claims handling and leadership experience.Key Responsibilities:Lead and Manage Team: Direct a team of Auto Injury Examiners responsible for...
-
Claims Examiner
23 hours ago
San Diego, United States Synectics Full timeDescription: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of...
-
Account Claims Representative II
3 weeks ago
San Jose, United States PMA Companies Full timeDescriptionAs a member of our Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance...
-
A/R Collections Supervisor
2 months ago
San Diego, United States Tandym Group Full timeTandym Group has an immediate opportunity for an A/R Collections Supervisor with a client in California. This contract will be 100% remote. This resource will be a working supervisor focused A/R, collections, follow-up, appeals, and denials specifically working with Epic HB. Must Have Experience:5 years of revenue cycle experience focused in A/R, Collections...
-
Manager, Claims Operations
2 months ago
SAN ANTONIO, United States USAA Full timeWhy USAA?Let’s do something that really matters.At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. We’re working as one to build a great experience and...
-
Supervisor, Arbitration
23 hours ago
San Antonio, United States Mpower Healthcare Full timeOverview HALOMD We are a fast-growing arbitration/medical billing company looking for a positive person who is interested in being a success and will help take the company to the next level. The seasoned professional for this job needs superior communication and computer skills including familiarity, with Microsoft Outlook, Word and Excel. This individual...
-
Quality Assurance Analyst
2 weeks ago
San Francisco, United States San Francisco Health Plan Full timeReporting to the Supervisor of Quality Assurance, the Quality Assurance Analyst performs intermediate and advanced level daily quality assurance reviews to ensure and report on the accuracy of claims processing end-to-end and other important business processes.Please note that while SFHP supports a hybrid work environment, you are required to be onsite and...
-
Senior Insurance Defense Trial Attorney
4 weeks ago
San Francisco, California, United States Farmers Group Inc. Full timeJob SummaryWe are seeking a highly skilled Senior Insurance Defense Trial Attorney to join our team in Northern California. As a member of our litigation team, you will be responsible for the competent, ethical, and diligent representation of clients in all cases assigned by your supervisor.Key ResponsibilitiesSupervise cases as assigned and handle cases...
-
Administrative Assistant
4 weeks ago
San Francisco, United States Restaurant Depot Full timePosition Title: Administrative Assistant Department: Administrative (Branch Level) Supervisor: Branch Manager FLSA: Non-exempt Position Summary: Performs Human Resources Related duties at the administrative level and may carry out responsibilities in some or all of the following functional areas: payroll, benefits, employee relations, new hire orientation,...
-
HR Generalist
1 day ago
San Francisco, United States D Boyd Enterprises Inc Full timeJob Type Full-time Description Summary/Objective The Human Resource Generalist is responsible for performing HR-related duties on a professional level and works closely with ownership in supporting designated franchise operations. This position carries out responsibilities in the following functional areas: benefits administration, employee relations,...
-
San Francisco, United States Wu Yee Children's Services Full timeThe Early Learning for All Program Tuition Specialist is responsible for the accurate and timely calculation of childcare provider attendance sheets monthly including full tuition and Tuition Credit Program. The Early Learning for All Program Tuition Specialist will conduct intake for Early Learning Program. The Early Learning for ALL Program Tuition...
-
Maintenance Supervisor
2 weeks ago
San Antonio, United States Brookdale Oakwell Full timeOverview Voted by Newsweek in 2024 as one of America's Greatest Workplaces for Diversity Early Access to Paycheck with Earned Wage Access is available for Hourly Associates (outside of CA) Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You’ll earn more than a paycheck;...
-
Risk Management Specialist
2 weeks ago
san diego, United States Out West Restaurant Group Full timeWe are seeking a detail-oriented and organized Risk Management Specialist to oversee and coordinate all aspects of our employee injury and guest incident claims process. This role involves identifying, assessing, and mitigating risks within the restaurant operations to ensure the safety and security of guests, employees, and assets. The Risk Management...