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Financial Operations Supervisor

2 months ago

Carlton TX United States Superior HealthPlan Full time

You have the opportunity to make a significant impact on the health of our communities. Superior HealthPlan is dedicated to improving the well-being of our members, one individual at a time. As a national organization, we offer competitive benefits and a flexible work environment.

Position Overview: Manage all activities and personnel associated with Claims Operations. Work collaboratively with Provider Services and Provider Relations to address and resolve claims challenges while assisting internal teams with claims submission guidelines to ensure efficient and precise claims processing.
  • Deliver technical assistance and knowledge to staff regarding claims and contract resolution and project submissions.
  • Facilitate seamless transitions of work across various departmental functions and responsibilities.
  • Identify, evaluate, test, and implement innovative processes within the department to boost productivity and quality.
  • Supervise and assess daily operations and workload distribution.
  • Analyze and report on team performance, identifying training needs and areas for improvement.
  • Act as a liaison among plan departments, corporate claims departments, various internal teams, and external vendors concerning all claims and contracting activities.
  • Provide management with essential data to enable swift resolution of claims issues and support management consistently.
  • Offer pricing guidelines on claims appeals, adjustments, and pending items.
  • Educate internal teams on provider billing standards and procedures, including the development and maintenance of training resources.
  • Ensure timely and accurate submission of contracts, contract implementation/configuration, and subsequent claims processing through provider setup, user acceptance testing, etc.
  • Monitor state changes in reimbursement and/or benefits and request necessary adjustments to configurations for accurate and timely implementation.

Qualifications:

  • Bachelor's degree or equivalent experience.
  • 3+ years of experience in claims processing or provider contract management within a managed care setting.
  • Prior experience leading a functional area or managing cross-functional teams on large-scale initiatives.

Superior HealthPlan provides a comprehensive benefits package that includes competitive compensation, health insurance, retirement plans, tuition reimbursement, paid time off, and a flexible approach to work arrangements. Actual compensation will be adjusted based on individual skills, experience, education, and other job-related factors permitted by law. Total compensation may also encompass additional forms of incentives.

Superior HealthPlan is an equal opportunity employer committed to diversity and values the unique perspectives of all individuals. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by applicable law.