Curative is searching for a Claims Supervisor to build and lead the growing operations to achieve top performance. This position successfully manages the day-to-day activities of the Claims Team. The key expectations, competencies, and requirements for the successful Claims Supervisor candidate are outlined below. Performs all duties below while maintaining compliance and promoting the mission of the organization.
ESSENTIAL DUTIES AND FUNCTIONS:
- Successfully manages the day-to-day operations of the Curative Claims Team
- Serves as a key point of contact for audits, claims payments, questions, and customer service.
- Ensure consistent training, auditing, and feedback is given to all staff.
- Consistently ensure the Claims Team meets/exceeds the following standards:
- Claims processing turn around.
- Procedural and financial accuracy
- Payment Cycle Review
- Manage the repricing process for non-par and OON claims in accordance with turnaround time standards and client specifications.
- Work closely with IT, Medical Services, System Support, to ensure efficiency.
- Work with Accounting, Executive and HR departments to define needed processes.
- Reviews High Dollar Claims for completeness and approves or denies payment using established guidelines and making all required internal notifications.
- Works with the System Configuration department to ensure proper benefit setup.
- Completes required sample of professional and facility claims to audit for accuracy, as required by the client.
- Completes focused audits for error trends identified during processing or pre-
release audit. - Identify claim analyst training opportunities and provider billing issues.
- Submits audit results to the Claims Manager for review and final submission to clients.
- Acts as claims team resource for claims questions and benefit interpretation.
- Provides claim staff training via email alerts and training sessions.
- Reviews results of all prospective/retrospective audits provided from various sources to ensure that claims processing is handled, as mandated, by client directives.
- Analyzes, tracks and trends provider, system setup and claim errors.
- Works on claims team projects and reporting, assigned.
- Assists with all groups for professional and facility claim processing.
- Attend departmental training when required or requested.
- Adheres to the rules and regulations of Curative as described in the Employee Handbook and as defined in the unit/department/clinic procedures.
- Performs other duties and projects assigned.
MINIMUM QUALIFICATIONS:
Education:
- High school diploma or equivalent. Bachelor’s /Associate degree preferred.
Experience:
- At least 3-5 years of Claims Supervisor and/or other insurance payer operations management experience (e.g., Appeals) required, including HMO, PPO, ERISA, or government plans experience.
- Experience working with Health Edge- Health Rules Payer system, a variety of claims payment systems, processing of all claim types, to include hospital/facility, behavioral health, dental, vision, and professional medical claims.
- Ability to create and use inventory management plans, workforce planning models, and performance metrics to optimize claim processing efficiency.
Knowledge, Skills, and Abilities:
- Ability to effectively communicate clearly and effectively with all levels of staff.
- Demonstrated ability to coach employees and teams for performance
- Demonstrated ability to consistently meet claim processing timeliness and quality metrics
- Knowledge of state prompt payment regulations and requirements for claims processing
- Knowledge of HIPPA regulations
- Knowledge of medical terminology, IDC-10 CPT, and HCPCS coding.
- Proficient computer skills to include Google-based applications (Docs, Sheets, Slides, Forms, etc.).
- Excellent verbal and written communication skills
- Talent management – Attract, retain, and develop top talent
- Ability to sit for extended periods of time at a computer workstation.
PHYSICAL DEMANDS:
SEDENTARY (requires lifting to 10 lbs., carrying small objects)