Claims Supervisor

4 weeks ago

San Francisco, California, United States Zenith American Full time
Job Overview

Zenith American Solutions is seeking an experienced Claims Supervisor to provide daily leadership and supervision to a Claims team in accordance with Company guidelines, client needs, and regulatory requirements.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Responsibilities
  • Leadership and Supervision
    • Provides daily leadership and supervision to staff consistent with Company values and mission.
    • Assigns, distributes, and monitors quality and quantity of work produced, ensuring employees are held accountable for consistently meeting quality and production requirements.
  • Staff Development
    • Develops staff through performance management, goal setting, training, and effective employee relations.
  • Claims Operations
    • Maintains current knowledge of assigned Plan(s) and effectively applies knowledge; provides oversight of processing activities to ensure compliance.
    • Optimizes workflows/processes, tools, and staff allocation to ensure efficient and cost-effective day-to-day operations.
  • Customer Service
    • Troubleshoots customer/client service issues and assists in the successful implementation of new clients.
  • Benefits Plan Management
    • Reviews and interprets new benefits plans or changes/updates to existing plans; tests benefits for validation and accuracy. Develops and distributes resource documents as needed.
  • Advanced Technical Review
    • Provides technical review of all types of claims including large dollar and complex claims to validate benefit allowance and category.
    • Investigates, evaluates, and reports on advanced cases for third-party recovery including stop-loss, accident, medical malpractice, subrogation, and Worker's Compensation.
  • Administrative Tasks
    • Compiles documents, records, and data for external audits, as requested.
    • Assists in the development and documentation of departmental SOP's.
Requirements
  • Education
    • High school diploma or GED.
  • Experience
    • Four years of experience processing complex health and welfare claims in a third-party administrator.
    • One year of experience in a lead or supervisory role.
  • Skills
    • Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes.
    • Thorough knowledge of claims operations to include payment of claims, interpretation of contracts, communication of benefits, etc.
    • Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly.
    • Highly developed sense of integrity and commitment to customer satisfaction.
    • Ability to communicate clearly and professionally, both verbally and in writing.
    • Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities.
    • Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment.
    • Computer proficiency including Microsoft Office tools and applications.
Preferred Qualifications
  • Experience working in a multi-employer or Taft-Hartley environment.
Working Conditions
  • Prolonged periods of sitting at a desk and working on a computer.
  • Must be able to lift up to 15 pounds at times.

Zenith American Solutions is an equal opportunity employer and welcomes applications from diverse candidates. If you meet the minimum qualifications and are interested in applying for this position, please submit an application. All applications must be received by 5:00 pm on the Internal Posting Deadline listed above in order to be considered prior. We are committed to providing a comprehensive benefits program to our employees and their families, including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), and great opportunities for growth and development.

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