What are the responsibilities and job description for the Supervisor, Claims position at Delta Dental of New Jersey?
About Us
Delta Dental of New Jersey and Delta Dental of Connecticut are proud to be leaders in the dental insurance industry, offering a wide range of plans to meet the needs of individuals and employers alike. As New Jersey’s largest dental coverage provider, we are committed to delivering high-quality, cost-effective solutions designed to meet the diverse needs of our customers and our team is growing.
In Connecticut, Delta Dental of Connecticut, Inc. provides fully insured dental coverage, while Delta Dental of New Jersey administers self-funded dental benefit programs. We proudly serve over 1.7 million individuals through more than 1,800 groups, including commercial, school board, and government programs.
Since 1969, Delta Dental has been at the forefront of innovation, offering programs that control costs while ensuring the highest level of benefits.
As a member of the national Delta Dental Plans Association, we provide national dental coverage to over 75 million people across 139,000 groups. Our commitment to excellence is reflected in our prestigious Standard & Poor’s “A ” rating for financial strength. Join us and be a part of a trusted company with a rich history of delivering quality dental benefits to millions.
We value our associates and support everyone with learning and development, active wellness and diversity initiatives, and volunteer opportunities at causes that you care about.
Job Summary
The Claims Supervisor leads daily operations of the Claims department, ensuring effective and efficient processing of dental claims. Other duties involve managing, developing, and supervising a team of claims examiners as well as handling escalated issues on various projects and initiatives. Supervisor will also work with Manager to continuously improve processes and ensure customer satisfaction.
Candidates who enjoy a challenge and are looking to grow within a fast-paced environment will be successful in this position. The ideal candidate will be responsible for conducting yearly performance evaluations and will be highly engaged in delivering industry leading performance. Ability to collaborate across departments is highly desired.
Essential Functions & Responsibilities
- Supervise and coach a team of Claims Examiners. Provide monthly feedback and regular performance reviews.
- Works in conjunction with Manager to ensure timely and accurate processing of claims.
- Handles escalated and complex issues as needed and may require processing of claims.
- Reviews, monitors, and completes daily claim reconciliation from Business Partners (end to end process to ensure claims reconcile). Includes saving all critical reports and daily SSAE16 emails to AVP/Operations.
- Reviews, validates, and enter Business Partners Quality Assurance errors.
- Reviews, validates, and runs monthly reports for Business Partners billing.
- Reviews and monitors claims inventory daily in claims systems and AX Workflow to assign work where appropriate.
- Partners with Quality Assurance to improve and minimize claims errors.
- Handles personnel actions including hiring, promotions, transfers, terminations, disciplinary measures as needed.
- Facilitates departmental meetings with Claims Examiners.
- Responsible for providing daily inventory status and goals for Claims Examiners.
- Works closely with other departments within and outside of Operations as needed.
- Participates in monthly meetings with DDNJ Business Partners to discuss deficiencies or improvements.
- Participates in projects as assigned, includes participating in meetings and/or user acceptance testing.
- Responsible for processing time sheets and overseeing attendance in accordance with Delta guidelines.
- Ensures that all Delta practices and policies are adhered to; enforces union contract
- Other duties may be assigned.
NON-ESSENTIAL
- May perform other functions as assigned.
Essential Qualifications
DDNJ Competencies
Analytical Skills | Accountability | Communication-Listening Skills | Customer Focus | Confidentiality |
Managing for Results | Problem Solving-Analysis | Attention to Detail | Managing Conflict | Dependability |
Knowledge, Skills & Abilities
Technical and Functional
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Demonstrated leadership skills are required to enhance team performance. The requirements listed are representative of the knowledge, skill and/or ability required.
Must have good analytical skills, paying attention to detail to ensure quality of work.
Required Physical Abilities
The physical demands 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.
- Ability to sit and perform extensive close keyboard and PC work
- Ability to walk, talk or hear
- Occasionally required to stand and reach with hands and arms
Working Environment
- Ability to meet deadlines and attendance standards.
- The noise level in the work environment is usually moderate.
- This classification will be required to sign a confidentiality agreement.
Experience, Education and Certifications Required
Experience Required
- Minimum of 3 years of claim processing and/or customer service experience preferred with at least 2 years in a supervisory role.
- Previous experience mentoring staff. Strong communication and problem-solving skills.
- Working knowledge of MS Office.
- Previous supervisory skills highly recommended.
- High level of attention to detail and organizational skills.
- Experience with process improvement methodologies a plus.
Required Educational Level
- The highest level of education desired for candidates in this position is an associate degree or equivalent experience.
