Humera - Administrative and Professional Staffing

Claims Operations Supervisor

Minnetonka, MN, United States
Contact For Rate
Feb 21, 2018
Feb 27, 2018
Job Type
Employment Status
Full Time
Humera is seeking a Claims Operations Supervisor for our client in Minnetonka, MN. This individual will be responsible for supervising a team of Claims Processors and ensures high-level quality and productivity in claims processing. The Claims Operations Supervisor is responsible for the timely and accurate adjudication and payment of claims or adjustments initiated by internal and external customers and provides coaching and mentoring to team members or peers.
Claims Leadership 50%
  • Provides day-to-day work direction and assignment of claims
  • May assist in the auditing functions of the department
  • Understands and is a resource to peers regarding departmental rules, regulations and policies to employees
  • Conducts performance reviews/feedback; creates orientation plan for new hires and coaches team as well as individuals on productivity and quality
  • Approves time off and timesheets
  • Serves as claims processing expert for other department personnel
  • Serves as proxy for the Claims Manager in the absence of the manager
Claims Processing Approval 20%
  • Screens and approves high-dollar medical claims
  • Reviews claims to ensure proper information to complete processing
  • Requests documentation to finalize claim
  • Works with peers and Claims Manager to manage the day-to-day inventory of their respective queues to ensure that turnaround time guarantees are consistently met
Claim Receipt Reconciliation, Payment Cycle Authorization and Reconciliation 20%
  • Compares electronic claims submit by EDI clearinghouse matches total claims received into HR; completes and reports reconciliation results; initiates investigation related to discrepancies
  • Initiates, reconciles and reports claims payment reconciliation; authorizes claim payment file; initiates investigation related to discrepancies
Claims Systems SME 10%
  • Participates in and leads projects related to automation improvements or software upgrade testing. Approves software upgrade approval upon review of testing results
  • Participates in and serves as SME expert in meetings with IT, Finance, Compliance, Configuration, Training Provider Services
  • Serves as Manager proxy in the absence of the Manager

Minimum education level required to qualify for the position:
  • Bachelor's Degree or four years of direct medical claims processing experience with 2 years in a lead or supervisory capacity in a medical claims processing environment Minimum years' experience required in the field to qualify for the position:
  • 3 years of complex direct medical claims processing experience with 2 or more years as a Lead/Supervisor in a medical claims environment
Specific types of experience or skills required:
  • Demonstrated flexibility to adapt to changes in procedures and job assignments
  • Proven ability to lead/supervise a team and independently seek solutions to problems
  • Prioritization skills in order to schedule work to meet deadlines
  • Excellent verbal and written communication skills
  • Well-developed analytical skills to evaluate and determine the appropriate course of action
  • Demonstrated ability to mentor, coach and assist others
Number of direct reports and titles:
  • 11 - Claims Processor II/III/Recoupment Specialist/Claims Operations Analyst
  • Daily reconciliation of claim files of $5m in billed charges and reconciliation of payment cycle of $4m three times per week
  • Daily approval of claims greater than
  • $10k in allowed charges.

    Monday - Friday 8:00AM - 5:00PM

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