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Form of workJob Description
Position Summary:
This individual will be responsible for the everyday people operations and direct supervision of the Clinical Professional Services team (Appeals, Fraud & Abuse, and Clinical Review). Responsible for ensuring all work is completed accurately and timely to meet or exceed client expectations. This individual is responsible for conducting timely and comprehensive performance reviews and provides counseling to employees as needed and required. The Supervisor position will need to work closely with other Operations leaders who, collectively, will have responsibility for all functions of Back End Operations, which include Benefit Services, Claims Processing, Data Entry, and/or Mailroom. Additionally, the Operations Supervisor will be responsible for coordinating with internal IT Helpdesk Support resources which may include providing level one troubleshooting support to operations staff before dedicated IT staff can provide higher level support needed. The supervisor is also responsible for performing audits of the work that is completed by staff members to ensure understanding and compliance with processing instructions. Ensures that staff have development opportunities through training and job assignments and conducts hiring as needed.
Essential Functions:
- Monitors claim baskets and makes necessary adjustments to workflow or schedules as needed.
- Understand or be willing to learn the front-line jobs of both the Claims Processing and FWA teams.
- Motivates and encourages all team members through positive communication, coaching, recurring 1-on-1 meetings, and soliciting and responding to feedback from team members.
- Performs employee goal setting, reviews, including recommending career path movement, promotions, salary increases, and disciplinary actions for all direct reports (typically 5 to 15 individuals).
- Responsible for partnering with Human Resources and staffing firms for interviewing and hiring personnel, including temporary, temp-to-hire, and/or contingent workers.
- Identifies departmental training needs and provides or arranges for appropriate training.
- Makes suggestions to management on business process improvements based on observations within the Operations environment.
- Plays essential role as a key stakeholder in organization-wide projects and strategic initiatives. Duties may include identifying and documenting impacts to operational procedures and workflows and effectively participating in the implementation and user acceptance testing of solutions.
- Communicates and implements new and changes in policies and procedures to team members, including the development of new desk procedure documents.
- Evaluates performance of personnel through quality assurance audits and reporting, including providing coaching as necessary.
- Completes bi-monthly payroll and maintains current attendance records on personnel.
- Maintains a good working relationship with clients and outside vendors.
- Maintains daily, weekly, monthly, and annual reports of essential production and statistical information used in the Operations Department.
- Monitors production, system errors, and all reports related to Operations.
- Coordinates with and responds to inquiries from other departments as needed, including urgent time-sensitive items such as creating IT Helpdesk support tickets on behalf of team members or researching and responding to BOI complaints.
- Reports any unusual system or employee problems to Manager or VP.
- Other duties as assigned.
Qualifications/Education/Experience:
- Associate degree with a Bachelor’s Degree preferred.
- Minimum of three years of previous leadership experience required, preferably in the insurance industry.
- Excellent computer skills and fluency with Microsoft Office suite, including Outlook, Excel, and Word required.
- Prior dental or medical background preferred, a clinical license is a plus, but not required for this role.
- Interpersonal and communication skills to work effectively with all levels of staff. Ability to maintain confidentiality.
- Strong organizational/time management skills and multi-tasking abilities. Must have demonstrated abilities to handle multiple competing priorities while being able to pivot from one area of focus to the next quickly.
- Detail-oriented; flexible and creative.
- Demonstrated strong coaching, interpersonal, and effective leadership skills.
- Ability to work well under pressure and meet deadlines/objectives with minimal direction.
- Strong supervisory, analytical, problem solving.
- Ability to understand and follow work rules, policies, and procedures. Ability to effectively communicate concepts and make presentations.
- Demonstrated experience leading people and getting results through others.
- Ability to think and plan strategically for organizational success.
- Strong interpersonal and communication skills.
- Leadership qualifications to include developing, leading, mentoring, and setting goals or each member of his/her team.
- Ability to think and plan strategically for organizational success.
Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Physical demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. Use of hands is required for such technological devices such as a computer, telephone, and others. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. The employee will be required to travel (sometimes long distances) to attend required meetings.
- Work environment: The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. The noise level in the work environment is usually minimal.
