Medical Claims Supervisor

This position is located in Cypress, CA

The Need:

We are seeking a Claims Supervisor to join our growing team. In this role, you will be responsible for providing leadership and oversight to the Claims team. Accountable for ensuring the team adheres to standard work and meets department key performance indicators.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

1. Proactively seek to improve the internal capabilities and service of the Claims Operations through process improvements and training.

2. Assist with the implementation of standard work to ensure that appropriate controls and compliance is maintained at all times.

3. Support training and provide guidance to the Claims Adjusters and Auditors, to ensure they are utilizing the appropriate Plan documents and training materials in order to attain key performance metrics.

4. Promote a learning environment that cultivates the skills and knowledge of all team members.

5. Maintain current department knowledge of plan documents, summaries of plan provisions and other plan materials.

6. Monitor and manage the team’s performance as it relates to quality, production and service standards.

7. Performance management to include goal setting, employee engagement and staff development.

8. Foster and maintain positive relationships with all internal and external participants.

9. Influence decisions cross-functionally among co-workers, peers and executive leadership.

10. Monitors and ensures excellent customer service to Plan Participants.

11. Professionally and effectively communicate with plan participants, Local Union representatives and employer representative, in-person, on the telephone, email, or US mail.

12. Handle escalated situations with courtesy and professionalism.

EDUCATION and/or EXPERIENCE:

· High School diploma or GED required.

· Bachelor’s degree from an accredited college or university or combination of education and experience preferred.

· 3 years of prior supervisory experience preferred.

· 5 years of claims processing experience required.

· Strong Medical Claims processing skills; PPO, Anthem JAA, Medicare and COB experience.

· Solid understanding of CPT, HCPC, ICD9/10 coding, medical and claims terminology or solid knowledge of dental ADA procedure codes (CDT) and terminology.

· Comprehensive knowledge of the Fund's and the Health Care Claims Departments' policies, procedures, and business rules.

· Able to utilize MS Office (Excel, Word and Outlook) proficiency required.

· Excellent interpersonal skills, communication skills with the ability to collaborate with teams at all levels of the organization. High attention to the principals of EQ and their application.