AF - Group · 13 hours ago
Supervisor, Claims
Michigan, United States
Full-time
Onsite
Mid, Senior Level
$72K/yr - $120K/yr
5+ years expAF - Group is seeking a Claims Supervisor to guide the Claims Department's operations. The role involves supervising a team, developing workflows, managing projects, and ensuring effective communication with stakeholders.
Health CareInformation TechnologyInsurance
Responsibilities
Supervise a team of Claims Specialists and others claim roles
Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality
Identifies and/or analyzes business problems and devise procedures for solutions to the problems
Develops and maintains an effective working relationship with customers
Effectively leads projects/teams in order to produce desired results
Responsible for corporate communication of project results
Develops and implements desk levels and policies and procedures for deviations of Advantasure standard processes
Participate in the CMS audit of MA plans performance
Manages daily inventory and Turnaround of claims inventory
Handle and resolve escalated phone calls/issues
Work to resolve individual conflicts and problems with a specific project or task
Provide Manager with information regarding performance of members of the Claims Team
Work with Human Resources to coordinate interviewing, hiring, and development of new hires to department
Coordinate with Vendors within the Claims system
Coordinate with Account Managers/Eligibility/Provider Relations, etc
Responsible for daily production (Individual)
Respond to subject matter expertise questions as needed
Approve and manage employee time sheets
Performs and holds 1:1 and Team meetings on a regular and consistent basis
Interacts, coaches, counsels, and trains a staff of claims examiners and supporting roles in accordance with company policies and applicable labor laws
Address and document performance issues; coach or discipline employees as necessary
Qualification
Required
Bachelor's degree in Business Administration, Computer Science, Information Technology, Health Care or other related field preferred
Five years' experience of Advantasure Platform systems experience with demonstrated technical knowledge that provides the necessary skills, knowledge and abilities
Two years of supervisory experience required
Knowledge of Medicare Advantage processes and Centers for Medicare & Medicaid Services (CMS) guidelines
Knowledge and experience of the standard Life Cycle of a Claim
Experience in the Claim Adjudication process for medical claim processing editing, pricing and procedures
Excellent verbal and written communication skills with an ability to disseminate information in an effective manner
Excellent interpersonal skills and ability to interact with employees at different levels within the organization
Strong analytical skills with high attention to detail
Ability to be flexible and work under tight deadlines
Ability to work independently, as well as with all levels of staff, leadership, and external partners and vendors
A strong working knowledge of Microsoft office products
Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management
Ability to work with and empower others on a collaborative basis to ensure success of unit team
Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques
Ability to effectively present budgetary and/or cost information, and respond to questions as appropriate
Ability to establish workflows, manage multiple projects, and meet necessary deadlines
Preferred
Relevant combination of education and experience may be considered in lieu of degree
Certification or progress toward certification is highly preferred and encouraged
Claims background in a Medicare Advantage Organization preferred
Previous experience of claims analyst using facets, or equivalent, for claims and enrollment systems preferred
Company
AF - Group
AF Group is a nationally recognized holding company whose affiliated insurance companies are premier providers of specialty insurance solutions offered through independent agents nationwide.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Kim Leggette
SVP Claims
Amy Fournier
VP ,Chief Actuary, Actuarial & Data Science
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