Claims Supervisor

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The Claims operations team at Avesis is responsible for timely and accurately processing all claims. This is the team's continual commitment to ensure provider payments are accurate and member benefits are maximized. We have a proven track record for processing clean claims within 30 calendar days or less, reducing provider abrasion and increasing member satisfaction.

The Claims Supervisor is responsible for direct oversight of Claims staff, claims processing workflows, queue management and daily transactional operations. This includes coordinating work-flow, leading efforts in error reduction, supporting team members with claim payment procedures, completing special projects, overseeing team performance, and providing supervision and support of staff. This individual will provide feedback to the Claims Leadership Team regarding identified processing trends, offer process improvement opportunities, raise general areas of concern found in routine review activity and/ or processing, ensure claims processing turnaroung times and quality benchmarks are achieved.

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

Apply knowledge of claims processing workflows, payment processes, and regulatory requirements while developing an understanding of Avēsis contract performance standards and related operational requirements.

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 provide performance guidance to staff, including planning and assigning work, setting clear job expectations, and developing 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.

Serve as an escalation point and first-line technical contact for claims processing issues raised by staff.

Provide general instruction and guidance to staff related to claim adjudication processes and issue resolution.

Create, maintain, and distribute inventory and production reporting on a weekly, monthly, and quarterly basis.

Lead and facilitate Claims Team huddles and meetings.

Apply critical thinking to research root cause analysis of claims issues and processing findings, problem solving at times independently.

Assist with special projects and perform additional responsibilities as assigned to meet business needs.

Core Competencies:

Knowledge of CPT, HCPC, Dental and diagnosis coding.

Knowledge of general claims processing principles.

Ability to pivot between competing priorities and execute responsibilities within tight deadlines.

Strong attention to detail and accuracy.

Strong organizational skills with the ability to manage multiple tasks and meet deadlines.

Behavioral

Competencies:

Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.

Initiative: readiness to lead or take action to achieve goals.

Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.

Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.

Detail-oriented and thorough: managing and completing details of assignments without too much oversight.

Flexible and responsive: managing new demands, changes, and situations.

Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.

Integrity & responsibility: acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.

Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.

Minimum Qualifications:

High School…