Supervisor, Claims Processing

POSITION SUMMARY The Supervisor of Claims Processing is responsible for leading day-to-day claims processing operations and supporting a team responsible for timely, accurate, and compliant claims handling. This role monitors inventory, productivity, quality, and service level performance; provides coaching and guidance to claims staff; assists with escalated claim reviews; and partners with internal stakeholders to resolve issues, improve workflows, and support a positive member and client experience.

The Supervisor ensures claims are processed in accordance with plan documents, regulatory requirements, client expectations, and established policies and procedures.

ESSENTIAL FUNCTIONS Monitor daily inventory, productivity, and quality reports to ensure claims are processed timely, accurately, and in alignment with applicable service level agreements.

Assign, prioritize, and balance work across team members to meet operational goals and support changing business needs.

Review claim handling trends, inventory levels, and quality outcomes to identify issues, recommend solutions, and support continuous process improvement.

Provide guidance and support for complex or escalated claim issues, including elevated authority reviews within assigned approval limits.

Partner with management and internal stakeholders to resolve escalated client, broker, provider, or member concerns and support workflow efficiency and accuracy.

Support new client, product, network, and process implementations by helping ensure team readiness and adherence to requirements.

Assist with audit preparation and follow-up by ensuring accurate documentation, reporting, and claim handling practices.

Promote compliance with plan documents, regulatory requirements, internal policies, privacy and security standards, including HIPAA and HITECH.Attend continuing education and required training as assigned.

Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.

Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.

Actively engage, coach, counsel and provide timely, and constructive performance feedback.

Other duties as assigned.

EDUCATION Bachelor’s degree or equivalent work experience required.

EXPERIENCE AND SKILLSA minimum of 3 years of medical claims analysis and adjudication experience required; dental and vision claims analysis experience preferred.

Demonstrated sustained performance with impact as a team lead, senior claims analyst, or individual contributor required.

Demonstrated leadership potential with the ability to lead, coach, motivate, and develop team members required.

Demonstrated understanding of claims management systems, claims workflows, and operational reporting.

Strong technical knowledge of CPT, HCPCS, ICD-10 coding, Coordination of Benefits, medical terminology, and applicable claims processing requirements.

Ability to monitor productivity and quality results and use data to identify trends, address issues, and recommend practical solutions.

Strong written and verbal communication skills with the ability to clearly communicate expectations and provide timely, constructive feedback.

Strong time management, organization, and prioritization skills in a fast-paced environment.

Demonstrated problem-solving, coaching, and conflict resolution skills.

Ability to handle sensitive, confidential, and escalated matters with professionalism and discretion.

POSITION COMPETENCIES Accountability

Coaching and Feedback Collaboration Customer  Focus Decision Making Execution Management People Leadership PHYSICAL DEMANDS This is a standard desk role that requires extended periods of sitting and computer…