Avēsis · 3 hours ago

Claims Supervisor

United States

Full-time

Remote

Mid, Senior Level

$51K/yr - $79K/yr

3+ years exp

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Responsibilities

Ensure direct oversight of Claims staff, claims processing workflows, queue management and daily transactional operations and completion and delivery of annual performance reviews.

Demonstrate knowledge and understand Avesis’ contracts and performance requirements, claims processing workflow, automated process implantation and payment process.

Ensure timely and accurate processing of claims as required by contractual and regulated time frames.

Manage claims inventory and make recommendations for improving outcomes.

Train, orient, mentor, and discipline staff.

Monitor, plan, and assign employee job requirements.

Development of specific goals and objectives for supervised team members.

Make certain quality and productivity standards are being met or exceeded by the team and individuals.

Assist management and processors in resolving aged claims or handling of claims adjustment projects.

Presenting topics and attendance in team meetings related to claims processing reviews and updates for company policies and procedures, audit findings, and other related communications.

Identify opportunities to develop and implement improvement plans for best operations and outcomes.

Testing of system modifications to guarantee accurate processing and outcomes.

Support audit activity including both internal and external audit activity when needed.

Participate in annual review and maintenance of departmental workflow and Standard operating procedures.

Communicate timely with internal Avesis stakeholders regarding pending or open deliverables.

Perform other duties occasionally as assigned.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims processing experienceSupervisory experienceMedicareMedicaidCommercial insuranceCPT codingHCPC codingDental codingClaims processing principlesMicrosoft applicationsAdobeWordExcelProcess improvement

Required

High School Diploma or GED.

Minimum 3 years claims processing experience required with previous supervisory or leadership experience.

Knowledge of Medicare, Medicaid, and/or Commercial insurance terminology and high-level claims' payment processes.

Strong skills using Microsoft applications (Adobe, Word, Excel, Etc.) and other windows-based tools.

Ability to work flexible hours to accommodate business needs in all time zones.

Excellent listening, communication (verbal and written).

As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.