Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
Position Purpose: The Claims Supervisor upholds and administers claims processing, oversees the daily operations of the Claims Department and ensures adherence to Health Choice policy and procedure and contractual and regulatory guidelines for claims administration.
- Oversee daily claims activities to ensure regulatory claims compliance
- Reviews claim adjudication logic for appropriateness
- Ensures policies and procedures relevant and updated
- Ensures appropriate work distribution for claims processors
- Implements and maintains claims processor production and quality standards
- Works with Documentation/Training staff to ensure appropriate new and on-going training
- Resolve staff issues related to claims operations, inclusive of HR issues and resolution
- Develop and maintain working relationship with other Departmental supervisors
- Holds regular meetings and in-services with staff
- Works with IS staff in order to ensure appropriate system modifications and setup, inclusive of updated regulatory fee schedules
- Oversees Claims Clerk staff for support functions, inclusive of running all robotic processing automation scripts and scanning vendor relationship
Education / Experience / Other Requirements
- High school or GED
- College preferred
Years of Experience:
- 5 years claims processing (medical billing may be substituted for 2 years)
- Team oversight or 1 year supervisor experience
- Claims processing, inclusive of 1500 and UB
- Medical terminology
- Computer, inclusive of Microsoft Office and proprietary claims systems
- Effective communication, verbal and written
- Management and organizational skills
- Medicaid, Medicare, AHCCCCS policies and procedures
- Ability to think analytically and make independent decisions
- Ability to lead a team