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Claim Processing Supervisor Downey CA Downey, CA

Claims Processing Supervisor Location: Downey

The Claims Supervisor will assist in the management of approximately 15-40 Claims Adjusters. Provides guidance and support, serves as mentor and coach to team members in order to ensure operational efficiency and effectiveness. Develops goals, objectives, and career paths for team members. Assists in maintaining customer satisfaction by ensuring timely responses to inquiries and quick resolution of claims issues and concerns.-Accountable for results and metrics related to department operations.


Essential Functions:
- Supervises assigned team members. Assists in hiring, training, timekeeping, and evaluating team members in assigned section. Provides coaching and mentoring to team members to enhance performance and development and promote team building. Identifies additional training needs and monitors performance against established indicators.
- Coordinates and communicates regularly with other supervisors to share information, best practices, systems issues, questions, training needs, and team performance status relative to process and quality standards.
- Work closely with Labor Management Partners and attend required meetings.
- Provides recommendations and assists management with budget development process..
- Responsible for monitoring provider disputes, customer inquiries and quality standards.
- Provide assistance to the Operations, Rework & Intake Managers, as needed.
- Participates in management team committees and task forces related to operations as assigned.
- Ensures compliance and government regulations including but not limited to those of Medicare, Medi-cal & Commercial
- Assist in reviewing internal controls to ensure proper adjudication and payment of claims.
- Develops schedules to ensure proper staffing and production levels are maintained.
- Collaborates with Utilization Review, Medical Centers, and other Administrative staff in resolving benefit interpretation and validity of claim charges.
- May assist in claims analysis during high volume periods.
- Assist with all customer service issues with internal and external customers.

Qualifications:

Basic Qualifications:
- Bachelor's degree in Business Administration or a related field, or 4 years of related work experience
- Minimum5 years medical claims processing experience
- Minimum of 3 years supervisory and project management experience
- Ability to work in a Labor Management Partnership environment
- Thorough knowledge of claims administration
- Knowledge of various contracts
- Familiarity of coding protocols and terms
- Knowledge of claims regulations
- Understanding of medical or clinical procedures
- Knowledge of claims processing as it pertains to Medicare, Medi-cal & Commercial compliance regulations, and working knowledge of another functional area
- Proficient in the use of Microsoft Suite (Excel, PowerPoint, Word and Access)
- Excellent verbal and written communication skills

Preferred Qualifications:
- Experience interfacing with external regulatory agencies.
- Knowledge of claims processing systems

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