Claims Clerk Supervisor

Supervisor Clerical Long Beach, Long Beach, CA, US

Salary: $80,000.00 Annually

The Claims Clerk Supervisor leads the daily clerical and claims-support operations of the Claims department, guiding a team of claims clerks through intake, imaging, data entry, adjustment, correspondence, and appeals-support workflows. Working under the Manager of Claims Operations, this role serves as a subject-matter expert on claims reprocessing and clerical procedures, drives quality and payment accuracy, and supports internal audits and compliance readiness.

The position operates in a modern, largely paperless claims environment built on electronic claim intake (EDI 837), electronic remittance (835), clearinghouse and health-plan portals, and digital document management. The Supervisor is expected to be comfortable adopting and working alongside AI-based and automation tools — such as intelligent document processing (OCR/indexing), auto-adjudication and exception-queue routing, and AI assistants that help draft correspondence, summarize claim and appeal history, and flag anomalies — while exercising sound judgment, validating tool output, and safeguarding protected health information (PHI) in accordance with HIPAA and company policy.

• Supervise, train, and mentor claims clerks; serve as the subject-matter expert on claims reprocessing and daily clerical procedures.
• Assign and balance daily workloads, monitor productivity and turnaround times, and ensure end-of-day close-out (batch cover sheets, log sheets, and the end-of-day email) is completed accurately.
• Communicate effectively with the Claims Manager and production staff, and coordinate with client services, external vendors, health plans, and other organizations to resolve claims issues.

• Oversee claims batching, filing of data-entered claims, and daily retrieval of health-plan files (e.g., pulling claims from the Humana SFTP/FTP and health-plan portals).
• Manage document imaging in OnBase and the Mail Room Scan Folder, including separation and scanning of multiple medical records (Mult MR), and use of OCR/intelligent document processing to index and route images for processing.
• Administer fax intake and distribution (Ring Central, fax folders) and ensure all source documents are captured and stored for adjudication.

• Perform and supervise data entry of CMS-1500 (HCFA) and UB-04 (UC) claims into EZ-CAP, and process corrected claims (MEDRVW) to meet turnaround-time standards.
• Apply adjustment codes, process copay reversals, resolve invalid billing formats / rejected claims and invalid NDCs, and correctly distinguish first-time claims from adjustments (e.g., Anaheim Global MEC vs. first-time claim).
• Work assigned queues and status codes (e.g., UDUNC, 252, 16), apply PS note codes accurately, and generate member/provider notices using the EOB Writer.
• Support the appeals and grievance (A&G) process: intake of paper and electronic appeals, maintenance of the Appeals Data Entry Log, and pairing appeals with the associated claim image.
• Forward Provider Dispute Resolutions (PDRs) appropriately (requires working knowledge of the PDR process) and respond to Health Plan Demand Inquiries.
• Prepare and track development correspondence — 1st and 2nd request letters for developed claims (mailed and email requests) and forwarding of letters for claims denied under B11.

• Perform eligibility look-ups and submit eligibility verification requests to confirm coverage prior to adjudication.
• Submit and follow up on provider and hospital add requests to keep provider and facility data accurate.

• Audit…