What are the responsibilities and job description for the Supervisor, Claims position at Amalgamated Life Insurance Company?
The Supervisor of claims is responsible for the direct supervision of the Claims Analysts and other assigned staff, and oversees all claim processing related activities and functions, including monitoring inventory, production, quality, as well as provide guidance to examiners on claims related questions and issues.
- Oversees the administration of the assigned claims processing unit, including all functions and processes required to process medical, hospital, vision, dental and other claim types.
- Performs personnel and job supervisory duties required to ensure that staff is meeting performance goals; conducts annual performance reviews; confirms production incentive; monitors employee attendance and lateness.
- Monitors individual analyst production and quality providing feedback, support, and instruction to assist staff with meeting goals.
- Manages claims inventory via Workflow with a goal of meeting required JAA and DOL turnaround time requirements.
- Provides daily guidance and technical instruction to the claims staff, ensuring that claims are handled timely and appropriately.
- Identifies training needs and coordinates with training department for any developmental training requirements.
- Works with quality assurance department to provide feedback and corrective action on claims quality.
- Must possess a working knowledge of all plans for which this position will be responsible for and keeps up to date on any benefit plan and procedural changes that must be communicated to staff.
- Oversees the claims correspondence ensuring handling within DOL timeframes; prepares responses if needed.
- Interfaces with AMCM on medical claim referrals and any pre-certification issues.
- Consults with appropriate personnel through-out the company to obtain information required to resolve and process claims.
- Maintains knowledge of eligibility requirements and understands the complexities of the system interfaces.
- Monitors and oversees the correct handling of high dollar claims ensuring timeliness of handling; reviews, examines, and directs processing of unusual or difficult claims
- Oversees the Anthem JAA mailbox and medical records to ensure timely response and handling.
- Oversees the review, distribution, and response to Customer Service and service/account rep referrals/ inquires.
- Handles various assignments or projects, as needed
- Provide support to other claims department as is necessary
- Escalate any claims issue that may negatively impact the overall departmental claims quality.
- Bachelors or Associates degree preferred.
- Supervisory or related experience preferred.
- Five or more years work experience in handling health insurance or self-funded claims.
- NYS A&H Adjuster license (to be obtained within 3 months of employment)
- Familiarity with industry terminology and claim related medical terminology.
- High level of organizational and problem solving skills.
- Excellent written and verbal communication skills.
- Team player and willing to collaborate with management team.
- Good computer skills, including use of MS Word and Excel.
