What are the responsibilities and job description for the Claims Supervisor position at HealthTexas Primary Care Doctors?
Job Purpose
The Claims Supervisor is responsible for overseeing and directing a specific assigned team and assist with review of delegated Managed Care Claims. Responsibilities include administering claims adjudication and payment, maintaining claim records, and providing direction to providers and/or claimants regarding coverage amount and benefit interpretation.
In addition, you will be responsible for contributing to the growth and success of HealthTexas while upholding our Mission, Vision and Values.
Culture and Values Expectations
At HealthTexas, we believe that our workplace culture is the cornerstone of our success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission “to deliver quality and compassionate care with outstanding service, every patient, every time”. As a Claims Supervisor at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.
The Claims Supervisor is responsible for overseeing and directing a specific assigned team and assist with review of delegated Managed Care Claims. Responsibilities include administering claims adjudication and payment, maintaining claim records, and providing direction to providers and/or claimants regarding coverage amount and benefit interpretation.
In addition, you will be responsible for contributing to the growth and success of HealthTexas while upholding our Mission, Vision and Values.
Culture and Values Expectations
At HealthTexas, we believe that our workplace culture is the cornerstone of our success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission “to deliver quality and compassionate care with outstanding service, every patient, every time”. As a Claims Supervisor at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.
- Integrity: Do the right thing, the right way, every time.
- Be honest and uphold commitments and responsibilities, earn the trust and respect of the team and those we serve, and maintain privacy and confidentiality.
- Compassion: Treat everyone with respect and dignity.
- Foster an environment of inclusivity and well-being, practice patience and empathy, and assume positive intent.
- Synergy: Collaborate to improve outcomes.
- Invite and explore new opportunities, promote effective communication and teamwork, take pride in yourself, your work and HealthTexas.
- Stewardship: Use resources responsibly and efficiently.
- Implement effective strategies to attain goals, achieve maximum productivity and results, and seek continuous knowledge and improvement.
- Monitor and control workflow of claims to ensure that claims are settled timely in accordance with cost control standards.
- Ensure execution of claim handling procedures; including appropriate determination of coverage, processing guidelines and metrics.
- Coordinate workflow and staffing of day-to-day activities as well as assigning and monitoring work of staff in order to adhere to productivity and quality standards to meet stated goals.
- Reviews and analyze claim reports to identify and address adverse trends by recommending strategies to correct.
- Effectively manage escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through.
- Responsible for compiling and submitting daily, weekly and monthly departmental reports to management.
- Provide feedback to team personnel and provide appropriate training.
- Other duties, as assigned.
- Minimum 5 years medical claims adjudication working experience, with at least 1 year of managerial or lead experience.
- Delegated Medicare Advantage Experience is a plus.
- Experience with claims adjudication software.
- Advanced Degree is preferred. In lieu of a degree, 5 or more years of relevant experience.
- Medicare guidelines and healthcare claims regulation knowledge
- Monday – Friday, 8:00 a.m. – 5:00 p.m., and as needed to complete projects.
- Travel to medical offices may be necessary for the purpose of providing benefit education.
- This job operates in an office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
