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Claims Processing Supervisor
2 months ago
We are seeking a highly skilled Claims Processing Supervisor to oversee the receipt, processing, calculation, payment, and reporting of monthly claims submitted by providers in compliance with contractual requirements, regulations, and agency policies and procedures.
Key Responsibilities- Supervise the receipt, processing, calculation, payment, and reporting of monthly claims submitted by providers in compliance with contractual requirements, regulations, and agency policies and procedures.
- Supervise Claims staff and implement plans to achieve goals, establish priorities, and set realistic completion dates.
- Provide telephone assistance and problem resolution to providers as needed.
- Conduct Claims team meetings, identify and coordinate training needs, and administer performance evaluations on all supervised staff.
- Assist in developing division goals and measurement systems of performance indicators.
- Track and monitor problematic customer service situations to identify trends or patterns of problematic service issues, and communicate findings to Department Manager so areas can be addressed through training, system enhancements, and individual performance review.
- Conduct prudent fiscal management of budget to provide continuous improvement of services and to control expenses.
- Participate in Department workshops.
- Other duties as assigned.
- College degree with a focus on Accounting, Business, or Human/Social Services preferred. Relevant, verifiable work experience may be substituted for college-level education.
- Minimum 2 years experience managing a claims processing unit or a program with a claims processing unit.
- Requires knowledge and understanding of the Child Care Assistance Program, the CalWORKs Child Care Subsidy Program, and the Child Care Food Program regulations.
- Must be detailed-oriented with the ability to detect errors, investigate problems, and seek appropriate clarification and resolution.
- Excellent analytical ability and process development skills. Must have strong multi-tasking and organizational skills. Excellent oral and written communication skills.
- Requires excellent customer relations skills, with the ability to work with diverse individuals and groups, including all organizational levels.
- Requires strong analyzing skills, including budget analysis, claims analysis, payment analysis, and identification of fraudulent activities.
- Must be able to work well under pressure and multi-task priorities to meet tight deadlines.
- Must provide proof of Covid-19 vaccination.
- Medical/Dental/Vision - 95% paid by employer.
- Employee Assistance Program.
- Voluntary Life and AD&D for Employee, Spouse, and Children.
- 401k Matching Options.
- Flex Spending (Health Care and Dependent Care).
- Mutual of Omaha (STD, Accident, & Critical Illness).
- Generous Sick and Vacation Time.
- Paid Holidays + Paid Winter Break from 12/24 - 1/1 (for select positions).
- Opportunity for Growth and Development.
- Robust Learning Management System offering the following continuing education units: PDC, HRCI, CEU, CPE, PDU, SHRM.
Crystal Stairs, Inc. is committed to building and sustaining a fully vaccinated, diverse workforce and culture. As part of this commitment, Crystal Stairs, Inc. provides equal opportunity in all of our employment practices, including selection, hiring, promotion, transfer, and compensation, to all qualified applicants and employees without regard to race, color, medical condition as defined by state law, ancestry, religion, sex, national origin, age, marital status, sexual orientation, gender, ethnic group identification, mental or physical disability, pregnancy, childbirth, and related medical conditions, or any other legally protected status.
Additional Requirements: Must be fully vaccinated and remain fully vaccinated against COVID-19. Per the CDC, fully vaccinated means at least 2 weeks after (1) a second dose in a 2-dose series, or (2) a single-dose vaccine, and this status and definition applies to COVID-19 vaccines currently authorized for emergency use or approved by the U.S. Food and Drug Administration.
