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Claims Operations Supervisor
2 months ago
Position Summary
The Claims Operations Supervisor is responsible for guiding, mentoring, and training Claims Examiners while fostering a culture of quality outcomes. This role involves recognizing opportunities for process improvements and adjustments to workflows to enhance team effectiveness and productivity. The supervisor will provide continuous feedback to the team and pinpoint areas for development and advancement. Independent decision-making, effective workload prioritization, and collaboration with other internal departments are essential to achieving corporate objectives.
Key Responsibilities
- Lead remote teams effectively, encouraging strong leadership and employee engagement.
- Offer comprehensive assistance for claims, appeals, internal departments, vendors, and clients.
- Oversee daily workload distribution and ensure timely resolution of claims.
- Conduct training sessions for new hires, vendors, and current staff.
- Manage escalated issues and process high-value claims and adjustments.
- Identify opportunities for process enhancements and establish supporting workflows.
- Review and ensure the quality of claims and logical modifications in systems.
- Support Customer Service and Client Services, addressing inquiries as needed.
- Guide employees to surpass quality and productivity benchmarks, addressing performance challenges.
- Conduct audits and manage payroll, schedules, and time-off requests.
- Document and address performance issues, conducting regular evaluations.
- Facilitate individual and team meetings consistently.
Essential Qualifications
- 5+ years in a leadership capacity, preferably in claims management.
- Proficient in Microsoft Word and Excel.
- 5+ years of advanced claims adjudication experience, including facility, professional, and ancillary claims.
- Exceptional written and verbal communication, interpersonal, and negotiation skills with a proven ability to prioritize tasks effectively.
- Strong analytical and problem-solving capabilities.
- Excellent organizational skills; ability to prioritize and multitask efficiently.
- Ability to build and maintain positive and effective working relationships with clients, colleagues, members, providers, and customers.
- Positive attitude, collaborative team player, adaptable to changing circumstances.
- Bachelor's Degree preferred or equivalent experience in the healthcare sector.
About Brighton Health Plan Solutions, LLC
At Brighton Health Plan Solutions, LLC, our commitment lies in enhancing how healthcare is accessed and delivered. We foster a diverse and inclusive culture that emphasizes encouragement, respect, and the promotion of diversity at every level. Our organization partners with self-insured employers, Taft-Hartley Trusts, health systems, and other third-party administrators, offering flexible and innovative third-party administration services. Our extensive experience in health plan management, proprietary provider networks, and advanced technology platforms enable us to provide clients with customizable tools that enhance member experiences, improve health outcomes, and achieve healthcare objectives.
Company Mission
Transform the health plan experience by delivering exceptional products and services to our partners.
Company Vision
Redefine healthcare quality and value by aligning the incentives of our partners in innovative ways.
DEI Purpose Statement
At BHPS, we encourage all team members to express their authentic selves at work, embracing the richness of diverse experiences. We are dedicated to cultivating a culture that promotes diversity, inclusion, and a sense of belonging at every level.
Annual Salary Range: $85,000 - $95,000
The salary range provided is a good faith estimate that may be offered to a successful applicant for this position and may be adjusted in the future based on various factors.
