Claims Supervisor
4 weeks ago
As a Claims Supervisor at Prime Therapeutics, you will be responsible for managing a team of claims processors to ensure timely and accurate processing of medical claims. Your primary goal will be to meet or exceed customer requirements and business objectives.
Key Responsibilities:
- Manage cross-functional team members to meet or exceed service requirements.
- Examine and analyze team performance, developing and implementing plans to improve service levels.
- Evaluate multiple reports to assess work distribution and delegation, ensuring client expectations and state regulations are met.
- Report performance results to account management.
- Demonstrate flexibility in assigning resources based on business needs and fluctuating inventory.
- Adhere to budget allocations.
- Provide ongoing feedback and coaching to ensure appropriate performance levels.
- Recognize and reward team members effectively.
- Follow corporate and departmental policies and guidelines.
- Utilize corporate tools for performance appraisals.
- Engage team members in development planning and progress.
- Identify training needs within the team.
Requirements:
- 5+ years of claims processing experience or a combination of claims processing and direct customer service experience.
- Knowledge of MS Office software, specifically Excel.
- Expert knowledge of medical terminology and ECD-9/CPT-4 coding experience.
- Experience in processing various products, including HMO/PPO and Indemnity under both fully insured and self-funded arrangements.
- Experience managing budgets.
- 1+ years of direct supervisory experience.
- Strong influencing, negotiation, and analytical skills.
Work Environment:
Prime Therapeutics is a fast-paced and dynamic work environment that is ideal for proactively addressing the constant changes in today's healthcare industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.
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