What are the responsibilities and job description for the Claims Operations Supervisor position at IntePros?
Claims Operations Supervisor – Offshore Vendor Oversight
The Claims Operations Supervisor – Offshore Vendor Oversight is responsible for the operational management, performance oversight, and quality assurance of offshore vendor partners supporting Independence Blue Cross Claims Processing operations. This role ensures vendor-managed functions are executed accurately, efficiently, and in compliance with contractual obligations, regulatory requirements, and departmental standards.
Key Responsibilities
- Provide day-to-day operational oversight and governance of offshore claims processing activities.
- Monitor vendor compliance with service level agreements (SLAs), key performance indicators (KPIs), quality standards, and regulatory requirements.
- Analyze daily, weekly, and monthly performance metrics including productivity, accuracy, turnaround times, and quality results.
- Evaluate workflow efficiency and partner with vendor leadership to optimize staffing, processes, and operational effectiveness.
- Serve as the primary point of contact for operational issues, escalations, and resolution management.
- Collaborate with internal business partners including Claims Operations, Quality, Compliance, IT, Finance, and Vendor Management to support operational alignment and issue resolution.
- Communicate and reinforce corporate policies, procedures, and process updates with offshore vendor teams.
- Lead root cause analysis activities related to errors, defects, or service failures and ensure corrective action plans are implemented and sustained.
- Support implementation of new initiatives, system enhancements, and operational process changes impacting vendor operations.
- Review and validate vendor training plans to ensure teams are properly trained on claims systems, workflows, and requirements.
- Provide coaching and performance feedback to vendor leadership to drive continuous improvement and operational excellence.
- Ensure all inquiries, follow-ups, and escalations are resolved professionally, accurately, and within established turnaround expectations.
- Prepare and analyze operational reports highlighting performance trends, risks, and improvement opportunities.
- Maintain operational standards that support an optimal customer and provider experience.
- Ensure systems, tools, and operational support processes required for vendor success are functioning effectively.
Qualifications
- Minimum of five (5) years of experience in insurance operations with demonstrated expertise in claims processing.
- Prior experience overseeing offshore or third-party vendor operations strongly preferred.
- Strong understanding of healthcare claims processing operations within a high-volume environment.
- Proven ability to analyze operational performance data, identify trends, and implement corrective actions.
- Demonstrated success managing sensitive operational and performance issues with professionalism, diplomacy, and sound judgment.
- Excellent vendor management and relationship-building skills with the ability to influence without direct authority.
- Strong organizational, planning, and time management skills with the ability to manage competing priorities.
- Ability to adapt quickly in a fast-paced and evolving operational environment.
- Excellent verbal and written communication skills, including the ability to clearly communicate expectations, feedback, and performance outcomes.
- Knowledge of local and BlueCard claims processing business, workflows, and applications preferred.
- Experience with HealthRules preferred.