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.

• 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.

• Bachelor’s degree or equivalent work experience required.

• A 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.

• Accountability
• Coaching and Feedback
• Collaboration
• Customer Focus
• Decision Making
• Execution Management
• People Leadership

• This is a standard desk role that requires extended periods of sitting and computer work