Healthcare Claims Supervisor

Position: Healthcare Claims Supervisor

Location: Remote, Eastern Standard Time (EST) based in the Continental United States.

Reports To: Program Director

J29 is an employee centered health and human service management consulting company that specializes in processing, reviewing, and analyzing claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes employee experience. Our team brings corporate performance where we provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs.

• Supervise a growing team of healthcare claims staff, with responsibility expected to expand as claim volumes increase.
• Provide daily work direction, assign priorities, balance workloads, monitor queues, and ensure timely completion of claims processing activities.
• Conduct regular individual and team check-ins, provide coaching, communicate expectations, and address operational barriers.
• Monitor attendance, productivity, quality, accuracy, and adherence to established procedures and performance expectations.
• Escalate staffing, performance, system, policy, or operational risks to the Program Director with recommended corrective actions.
• Support employee onboarding, cross-training, knowledge development, and succession planning as the team expands.

• Provide supervisory and technical oversight for end-to-end healthcare claims intake, review, adjudication, payment, denial or rejection, adjustment, and escalation processes.
• Serve as an operational subject matter expert for complex claims, claim edits, exceptions, reimbursement questions, and processing issues.
• Ensure consistent interpretation and application of program requirements, benefit rules, covered conditions, reimbursement guidance, and claims processing procedures.
• Review and help resolve complex or escalated claims issues using applicable policies, procedures, system information, and supporting documentation.
• Partner with program leadership and cross-functional stakeholders to address recurring claim issues and improve processing consistency.

• Oversee coordination of benefits processing, including primary and secondary payer determination, Medicare coordination, Other Health Insurance (OHI), workers compensation coordination, and related recovery activities.
• Ensure COB claims are processed in accordance with program rules, payer order requirements, available remittance information, and established procedures.
• Provide guidance on complex COB scenarios, payment calculations, duplicate coverage, liability considerations, and claims requiring additional information.
• Identify COB-related trends, errors, and training needs, and recommend procedural or system improvements.

• Support the design, implementation, and startup of new healthcare claims operations and major program changes.
• Participate in business requirements reviews, workflow design, claims scenario development, user acceptance testing, defect triage, operational readiness reviews, and go-live support.
• Help establish staffing plans, work assignments, escalation paths, quality controls, productivity expectations, and standard operating procedures for new operations.
• Validate that claims workflows and system configurations support program requirements, business rules, benefit limitations, COB requirements, and operational expectations.
• Identify implementation gaps, dependencies, and risks and communicate recommended solutions to the Program Director.

• Use the PLEXIS claims system, or comparable claims administration technology, to support daily claims operations, queue management, issue research, and staff guidance.
• Assist with system workflow validation, claims testing, edit review, defect documentation, and confirmation that approved fixes operate as intended.
• Coordinate with technical and operational stakeholders to resolve system issues affecting claims processing, COB, quality, or productivity.
• Document system workarounds, known issues, and processing guidance until permanent solutions are implemented.

• Conduct or oversee claims quality reviews, calibration sessions, root cause analysis,…