Claims Supervisor

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $50.8k - $99.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Avēsis

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1978

🛡️ Insurance

⚕️ Healthcare Insurance

🧘 Wellness

Insurance • Healthcare Insurance • Wellness

Avēsis is a company dedicated to providing comprehensive specialty benefits focused on improving access, equity, and health outcomes. Specializing in dental and vision plans, Avēsis offers flexible, affordable, and outcome-focused oral health benefits as well as vision plans that connect eye health to overall well-being. With over 40 years of experience, Avēsis is committed to personalized care and building community health networks to service government partners, commercial providers, employers, and brokers. Avēsis operates as a wholly owned subsidiary of Guardian, and leverages tailored network and product solutions to deliver accessible quality care to members, while also administering Medicaid, Medicare, and other essential benefits programs.

📋 Description

• Provide direct oversight of Claims staff, claims processing workflows, queue management and daily transactional operations • Coordinate workflow and lead error-reduction efforts • Support staff with claim payment procedures and provide supervision and performance guidance • Complete annual performance reviews and establish goals and objectives for supervised team members • Ensure claims are processed accurately and within contractual and regulatory timeframes • Manage claims inventory and recommend improvements • Train, orient, mentor and assign work to staff • Resolve aged claims and support claims adjustment projects • Present claims-processing topics and updates in team meetings • Develop and implement operational improvement plans • Test system modifications for accurate processing and outcomes • Support internal and external audit activity • Maintain departmental workflows and standard operating procedures • Communicate with internal stakeholders regarding pending or open deliverables • Serve as an escalation point and first-line technical contact for claims-processing issues • Research root causes, troubleshoot issues and perform problem solving • Create, maintain and distribute weekly, monthly and quarterly inventory and production reports • Lead Claims Team huddles and meetings • Assist with special projects and additional responsibilities as assigned

🎯 Requirements

• High School Diploma or GED • Minimum 3 years of claim processing experience required • 2+ years of prior supervisory or leadership experience • Knowledge of Medicare, Medicaid, and/or Commercial insurance terminology and high-level claims payment processes • Intermediate proficiency in Microsoft Office products, including Excel, Word, Adobe, and other Windows-based tools used to aggregate, analyze, trend and report recommendations • Ability to work flexible hours to accommodate business needs in all time zones • Maintain internet service sufficient to complete essential remote job duties; 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient • Knowledge of CPT, HCPC, dental and diagnosis coding • Knowledge of general claims processing principles • Ability to manage competing priorities and tight deadlines • Strong attention to detail and accuracy • Strong organizational skills and ability to manage multiple tasks and meet deadlines

🏖️ Benefits

• Competitive compensation package • Medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period • Life and disability insurance • 401(k) with company match • Tuition assistance • Paid parental leave • Backup family care • Flexible time off • Flexible dress code and work location policies • Employee Resource Groups • Social responsibility and community volunteering opportunities