Supervisor, Claims Department - The Health Plan

 
Position: Supervisor, Claims Department - The Health Plan

Location: US-TX-Houston

Talent Area: Professional - Non-Clinical

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for a Supervisor/Claims Department - someone who works well in a fast-paced managed care setting. In this position, you’ll serve as a front-line supervisor by managing and directing the activities of a team of Claims Examiners and Claims Benefits Specialists. You’ll handle claims processing concerns and issues requiring a high degree of appropriate knowledge, creativity, research and communication with internal and external resources to achieve timely resolution. Additionally, you’ll ensure resources are utilized efficiently, in accordance with Claims Administration objectives that consistently promote internal and external customer quality and satisfaction.

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

  • Provides direct supervision of the daily operations for Claims Examiners and Claims Benefits Specialists
  • Proactively identifies and solves problems with timely resolution of complex issues referred by Claims Examiners and Claims Benefits Specialists. Identifies the most appropriate course of action for problem resolution and effectively communicates the plans to those impacted.  These issues frequently require research, collaboration with other departments, communications with external resources, and response creation
  • Provides daily monitoring for Claims Examiners and Claims Benefits Specialists production stats
  • Obtains daily stats of each team member’s production goals to review with Manager. Develops a successful plan to increase each team member’s production while maintaining accuracy
  • Provides front line questioning/answer and research
  • Responds to a claims processing question rapidly and accurately in order to meet the Claims Examiners and Claims Benefits Specialists expectations of timely processing of claims in queue via email or discussion. Resolves all questions on a daily basis accurately with a result of no pended claims or penalties
  • Performs post training follow up and review
  • Monitors and audits specified criteria based on claims training to assure perception of policy and procedures guidelines was comprehended. Coordinates with trainer/manager a resolution to problems identified post training where a comprehension gap can be diminished
  • Participates in quality initiatives and Performance Management
  • Assists the Manager with conducting performance reviews and team meetings
  • Initiates and complete check run process
  • Compiles and reviews Internal reports to identify any incorrect claims payment for all product lines for the weekly check run. Completes actual check review process and forwards for check process on same day as check push every week
  • Manage Workforce
  • Serves as initial point of contact for all issues regarding work schedules


Qualifications:

Requirements

  • High school diploma
  • A minimum of five (5) years of claims processing experience
  • Previous Supervisory experience highly preferred


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