Claims Investigation and Recovery Supervisor

2 weeks ago

Seattle, Washington, United States Community Health Plan of Washington Full time
Position Overview

About Us

Community Health Plan of Washington is dedicated to fostering a diverse and inclusive workforce. We are an equal opportunity employer, and all qualified candidates will be considered for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our Commitment:

  • Implement an equity perspective in all our initiatives.
  • Work towards minimizing health disparities.
  • Strive to be an anti-racist organization.
  • Foster an equitable workplace environment.

Role Summary

This position is accountable for supporting the Director of Claims Integrity by leading efforts in cost recovery and claims investigation. This includes direct oversight of team members, coordination across departments, and management of vendor relationships.

Key Qualifications:

  • A Bachelor’s degree or a combination of relevant education and experience is required.
  • A minimum of 5 years in managed healthcare or health insurance, specifically in claims, operations, eligibility, project management, process enhancement, and team supervision is essential.
  • At least 3 years of experience in employee supervision, covering hiring, performance management, and coaching.
  • Experience with State and Federal programs is preferred.
  • Strong analytical and problem-solving abilities are crucial.

Core Responsibilities:

  • Oversee all supervisory functions, including hiring, performance evaluations, training, and development of team members, while fostering a supportive work environment.
  • Lead a proficient team to manage daily operations related to cost recovery and claims investigations.
  • Identify and implement process improvements to enhance existing programs.
  • Manage vendor relationships for subrogation activities, reclamation, and cost avoidance.
  • Analyze trends in provider inquiries and develop effective resolutions to enhance productivity, ensuring staff are equipped with necessary training and resources.
  • Establish effective processes for managing cross-departmental collaborations, ensuring clear communication and resolution of issues.
  • Address inquiries and complaints from regulatory authorities.
  • Propose corporate policies based on a comprehensive understanding of industry standards and regulatory requirements.
  • Assist in creating standard processes for monitoring and reporting program performance, collaborating across technical and departmental units to define necessary business requirements.
  • Seek opportunities to enhance corporate performance in claims-related areas.
  • Participate in audits as required.
  • Direct and oversee work assignments, project delegation, and timekeeping for team members.
  • Collaborate with the Director to establish team policies and procedures.
  • Regularly report on departmental activities, integrating feedback and recommendations.

Essential Skills and Abilities:

  • Excellent verbal and written communication skills.
  • Ability to address and resolve team issues effectively and promptly.
  • Project management expertise, including the ability to implement and track new programs to completion.
  • Strong analytical and problem-solving skills.
  • Knowledge of process improvement and management.
  • Capability to mentor and develop team members, encouraging growth and improvement.
  • Ability to train others effectively.
  • Proficient in planning, assigning, and supervising the work of others.
  • Ability to collaborate effectively with various management levels.
  • Sensitivity to the needs of individuals, ensuring respect and fairness.
  • Ability to work with diverse individuals and circumstances.

Hiring Criteria:

  • Successful completion of a criminal background check is required.
  • Must not have been sanctioned or excluded from federal or state healthcare programs.
  • Vaccination requirements apply, with processes available for medical or religious exemptions.
  • Candidates with disabilities who can perform essential job functions with reasonable accommodation are considered fully qualified.

Compensation and Benefits:

This position is classified as FLSA Exempt and is not eligible for overtime. The position grade is 66, with a 10% annual incentive target based on performance metrics.

Community Health Plan of Washington offers a comprehensive benefits package for full and part-time employees and their dependents, including:

  • Medical, Prescription, Dental, and Vision coverage
  • Telehealth services
  • Flexible Spending Accounts and Health Savings Accounts
  • Life Insurance and Disability coverage
  • 401(k) Retirement plan with employer matching
  • Employee Assistance Program
  • Generous paid time off, including PTO and holidays

Physical and Mental Requirements:

Sensory: Requires speaking, hearing, and visual acuity.

Physical: Involves extended periods of sitting and computer use, with occasional lifting and carrying (up to 25 pounds).

Mental: Requires frequent decision-making and the ability to assess data and apply knowledge to unique situations.

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