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UNITE HERE HEALTH · 12 hours ago

Claims Supervisor

Oak Brook, IL

Full-time

Hybrid

Mid, Senior Level

$70K/yr - $88K/yr

4+ years exp

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry. The Claims Supervisor will oversee the claims production team, ensuring accurate and timely handling of medical, vision, dental, and short-term disability claims while providing leadership and support to the team.

ConsultingHealth CareHospitalNon Profit

Comp. & Benefits

Responsibilities

Provides leadership, motivates, advocates, coaches and develops team performance and promotes Fund culture/mission along with advocating for appropriate change with a positive attitude

Holds direct reports accountable for individual performance, which may result in disciplinary action

Promotes operational efficiency and quality by critically analyzing team processes with the intention of improving member experience and creating a high level of consistency in the team’s quality and production results

Manages and reports on team inventory to ensure that departmental metrics are met

Successfully investigates and responds to escalated inquiries from internal and external sources

Allocates and cross trains team resources to complete goals

Assists in training to other UHH operational areas

Collaborates and partners with other Claims Department Supervisors to ensure consistency in processing across all teams and to identify ways to be BETTER, more efficient, adaptable and participant focused

Ensures adherence to policies and procedures are consistently applied

Assists in the design and preparation of management reports

Collaborates with the Legal team to understand legal regulations and plan provisions

Demonstrates necessary competence in technical, industry standard and soft skills to effectively support and develop staff

Communicates with Executive Leadership through creation of the monthly Claims Department Dashboard

Interacts with members and UHH operational areas to resolve complex issues

Interacts with members and UHH operational areas to educate regarding policies and procedures

Strictly adheres to all regulatory and legal requirements, including time deadlines

Ensures members Coordination of Benefits information is accurately and consistently updated and maintained

Oversees the creation and maintenance of provider records for accuracy and claim payments, as well as, annual 1099 reporting to IRS

Demonstrates personal accountability for personal actions as well as team and departmental results through ensuring claims and correspondence are handled in accordance with the guidelines set forth by the DOL and our internal Claims Policy Committee

Plans, analyzes, and evaluates programs and services, operational needs, and fiscal constraints

Supervises, leads, and delegates work and coaches, mentors, develops employees

Analyzes problems, identifies and develops alternative solutions, projects consequences of proposed actions and implements recommendation/solutions

Recommends hires and promotions, directs and evaluates employment decisions for all assigned positions

Assists with developing and coordinating policies and procedures

Responsible for the oversight of continued employee training requirements, safety and quality initiatives

Qualification

Claims Processing KnowledgeSupervisory ExperienceWelfare Plan AdministrationMicrosoft OfficeMedicareMedicaid KnowledgeSpanish FluencyCoachingTeam LeadershipMentoringProblem SolvingCommunication Skills

Required

Bachelor's degree in related field or equivalent work experience required

4 ~ 6 years of direct experience minimum

3 ~ 5 years of supervisory experience required

Intermediate level Microsoft Office and Excel skills

Professional level training that provides working knowledge of: Administration of welfare plan benefits, High degree of Claims Processing Knowledge, Understanding of Medicare, Medicaid, ACA, DOL regulations, ERISA and HIPAA, Audit and billing procedures, Plan documents and summary plan descriptions, Vendor relations, Eligibility rules