Description
Network Health's success is rooted in our mission to enhance the life, health, and wellness of the people we serve. This mission drives every decision we make, including the selection of individuals who join our growing team.
We are looking for a Claims Production Supervisor to support the daily operations of the Claims Production Department, including outsourced vendor management, across multiple lines of business.
Key responsibilities include :
- Supervising claims production and ensuring efficient workflow.
- Hiring and managing team performance.
- Prioritizing daily work and projects.
- Assisting the Manager of Claims with overall department performance.
- Serving as a resource for the team and representing the department in meetings.
- Leading special projects and addressing emergent issues.
- Ensuring compliance with state mandates and regulations.
This role requires strong leadership, problem-solving, and industry knowledge to maintain operational efficiency and excellence.
Essential Job Duties :
Demonstrates commitment and behaviors aligned with the philosophy, mission, values, and vision of Network Health.Applies organizational, regulatory, and credentialing principles, policies, and procedures to the claims production process. Assists the Manager of Claims Production and / or Manager of Claims Recovery with regulatory reporting and compliance audits, including Data Validation, Financial Audits, and CMS Program Audits.Monitors and tracks Service Level Agreements (SLAs) and Key Performance Indicators (KPIs), identifies patterns, and escalates issues to leadership as needed.Supervises assigned claims staff, including hiring, training, performance evaluations, salary recommendations, and managing discipline and termination processes. Collaborates with the Manager of Claims Production on hiring, salary decisions, discipline, and terminations. Provides performance feedback to improve the skills and performance of both claims and claims recovery staff.Coordinates staffing schedules to maintain optimal staffing levels. Establishes department turnaround times and production rates. Sets departmental priorities and develops efficient workflows to meet objectives. Ensures compliance with desk procedures and regulatory requirements.Prepares and analyzes daily, weekly, and monthly operational reports, distributing relevant data to appropriate departments. Works with the Manager of Claims Production to set claims-related goals and develop strategies to meet them.Maintains communication with other Network Health departments to assess and improve the effectiveness of the claims function, including standardizing and documenting policies and procedures, facilitating new policy implementation, and identifying opportunities for internal efficiency improvements.Recommends and oversees employee training for claims staff. Organizes and leads regular staff and department meetings.Performs claims-related tasks, such as processing high-dollar claims, monitoring suspended claims reports to ensure timely resolution, and serving as a liaison between the claims department and other departments. Documents results in QNXT, TMG FACETs, TMG Call, and QuickBase applications.Other duties as assigned.Minimum Education Required :
Associate Degree or equivalent experience required. Bachelor's degree preferredMinimum Related Years of Experience (per minimum education) Required :
One year of experience in a leadership role, preferably in a health insurance industryAt least two years of health insurance claims experience is requiredCandidates must reside in the state of Wisconsin for consideration. This position is eligible for our hybrid workplace model to work at your home office (reliable internet is required), and at our office in Brookfield or Menasha.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.
