Job Description

The Claims Supervisor upholds and administers claims processing, oversees the daily operations of a specialized functional team within the Claims Department and ensures adherence to Health Choice policy and procedure and contractual guidelines for claims administration.

This individual will become an expert in benefit plans and teach claims processors or adjustors to administer benefits appropriately based on benefits plan. In addition will be responsible for quality outcomes for team, will drive projects for process improvement, and will ensure provider satisfaction from the first touch of our claims via ensuring production and quality standards being met by the team.

The Claims Supervisor will be responsible for hiring, mentoring, coaching, performance evaluations, policy review and approvals, and scheduling for their team
The Claims Supervisor will work with Claims Department, Operations Directors, and trainer/supervisors to ensure proper administration of all benefits. They will attend all meetings related to line of business or claims department business as directed. Also will be supporting the Claim Director in projects and hiring or interviewing assistance for all new claims staff as needed.

Assure department efficiency and effectiveness
* Oversee day-to-day activities of the Claims Department and/or Claims Resolution Services
* Meet with Director on a regular basis to assess departmental operation and activities
* Resolve staff issues related to the operation, claims system or specific claim
* Achieve financial objectives
* Communicate job expectations to staff
* Plan, assign, monitor, and appraise employee’s job results
* Develop, implement, and enforce policies and procedures
* Maintain, train, orient, mentor and evaluate staff
* Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Health Choice employee
Ensure that claims are adjudicated accurately and in a timely manner:
* Review high dollar claims to ensure only allowable charges were paid
* Monitor claim inventory levels
* Assign duties to staff to ensure timely claims adjudication
* Monitor provider and member assignment
* Monitor phone activity
* Ensure that calls are properly handled and that the call abandonment rate is less than or equal to 5%
Interface with personnel from various contracts regarding updates and revisions:
* Train claims staff on new or updated information

Interface with Health Choice IS department and identify and participate in development of system modifications:
* Request modification/enhancements
* Test completed modifications
* Train staff in use of modifications

Demonstrate leadership behavior in individual performance as well as outcome of departmental goals:
* Demonstrate problem solving skills
* Demonstrate effective written and verbal communication skills
* Provide valid feedback to Claims Director on departmental issues and progress


Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



High School Diploma or G.E.D.
Some college in business or health care preferred

At least two (2) years supervisory experience, preferred
At least two (2) years claim processing experience in HCFA 1500s and UB92s or Medical Claims Billing, preferred
At least one (1) year computer/data entry or 10 key by touch

Knowledge of medical terminology
Knowledge of ICD-9/ICD-10 (when applicable)
Knowledge of CPT Codes and HCPCs codes
Claims billing - 1500s and UB92s
Continuation Plans

Ability to supervise and lead others
Ability to think analytically and make independent decisions
Ability to manage large workload
Ability to maintain a positive work environment for employees
Ability to maintain positive work relationships
Handle multiple and changing priorities at a fast pace
Work cooperatively, positively, and collaboratively in an interdisciplinary team

Computer experience necessary
Effective time management and organizational skills
Effective interpersonal and communication skills

Application Instructions

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