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Gravie · 1 day ago

Medical Claims Supervisor

United States

Full-time

Remote

Mid, Senior Level

$59K/yr - $99K/yr

Gravie is dedicated to improving healthcare access through innovative health benefit solutions. They are seeking a Medical Claims Supervisor to manage the operational performance of claims examiners, ensuring accurate claims processing and enhancing the member experience.

Employee BenefitsHealth CareInsuranceInsurTech

Responsibilities

Oversee, mentor and evaluate claims examiners at all levels, including inventory assignment, KPI monitoring and performance management

Lead claims processing and inventory management to ensure timely, accurate and compliant adjudication of claims

Analyze quality review findings from the auditing department to identify root causes of financial, payment and procedural errors at the examiner level

Identify operational gaps and provide recommendations, implement continuous improvements related to claims processing, system configuration, and quality outcomes

Act as the escalation point for complex claims, leading investigation, resolution, and implementation of both short-term and long-term corrective solutions

Prepare and analyze claims processing reports, leveraging claim data to deliver insights that drive operational efficiency. Partner closely with Data Analytics to identify reporting gaps and ensure consistent achievement of KPI’s and Network SLA’s

Compile and present key operational and performance data in a clear, organized, and concise format. Highlighting trends, risks and actionable insights for leadership and key stakeholders

Collaborate cross-functionally with internal departments such as Clinical, Configuration, Compliance and other departments to develop, refine and improve policies and procedures

Serve as a backup to the Claims Manager as needed to support business and departmental needs of the business

Oversee, maintain, and enhance workflows to improve departmental effectiveness, scalability, and efficiency

Lead through change in a fast-paced, evolving environment; demonstrate agility, effectively prioritize shifting demands and communicate urgent issues effectively

Be willing to maintain a flexible work schedule, based upon the needs of the business and Claims department

Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and result-driven mindset

Qualification

Claims processingMedical terminologyCPT/ICD codesClaims adjudication systemsHealthcare lawsStaff managementData analysisCommunication skillsProblem-solvingTeam collaboration