Healthcare Claims Supervisor

Elite Technical is seeking a Claims Supervisor (Review and Recovery) to support our client, a health plan in the Elkridge MD area. The selected candidate will manage the claims inventory and Review and Recovery staff through timely and accurate processing of higher level claims. To manage the processing of claims adjustments through the correction of errors and handling of overpayments and underpayments. To manage reporting and working of reports pertinent to this unit in a timely and accurate manner.

This person supervises, motivates, directs and guides employees in the analyzing and adjusting of claims including, but not limited to, the following: OIC/COB, SNF, DRG, Travel Claims, Medicare, Tricare, Foreign Currency, Managed Care, PPO, Workers- Compensation, and subrogation.

This position also supervises and directs employees in handling and resolving identified discrepancies in the processing and payment of the applicable claims. With regard to discrepancies in payment, the position must determine if a resulting overpayment/underpayment exists, and reprocess the claim accordingly. Therefore, the incumbent must possess a thorough knowledge of the processing guidelines and procedures applicable. The supervisor is the liaison between the overpayment and subrogation recovery vendors and provides any assistance required in pursuit of recovery. Thorough understanding of subrogation and recovery methodologies required.

The supervisor is responsible for managing all resources in the unit so that predetermined objectives are met on a timely basis. This includes, but is not limited to: administering Plan policy and disciplinary action, handling employee/labor-relations issues, allocating resources based on workload considerations, and ensuring that appropriate processing policies and guidelines are developed, and followed consistently.

The position is responsible for maintaining, developing and reporting on unit statistics, objectives, procedures and reports; administering the Quality Assurance and Standards program; creating unit staffing models and projections. Also, representing the unit in various capacities within the Plan, including representing the unit in meetings and on projects as necessary.

PRIMARY ACCOUNTABILITIES:

- Meet given objectives pertaining to cycle time, QA and productivity.
- Operate within the unit administrative budget.
- Manage unit workflow and inventory.
- Respond to staff questions quickly and accurately.
- Maintain reporting of daily/monthly activities and goals of the unit.
- Update standards and write/update unit procedures on a timely basis and as needed.
- Administer Plan personnel policies/CBA accurately and equitably.
- Complete assignments in a timely manner.
- Initiate IT tickets for system issues.
- Manage all of the R&R reports in a timely manner and accurately report those results to as needed on a given timeline.
- Ensure cross-training of staff on all -specialty- claim types.
- Provide supplemental training to staff as needed.
- Participate and/or collaborate on assigned Health Plan projects, committees and meetings.

Required Skills:

- AA degree (or commensurate experience) preferred
- 4 years experience in a supervisory position. Leading Claims Adjusters is required
- Extensive healthcare claims and claims adjustment knowledge
- QNXT processing experience is a big plus
- Must have subrogation, Medicare, Medicaid and OIC/COB experience.
- Decision making/problem-solving skills.
- Motivational/leadership skills.
- Good verbal and written communication skills.