What are the responsibilities and job description for the Claims Supervisor position at KHS?
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
KHS reasonably expects to pay starting compensation for the position of Claims Supervisor in the range of $83,625 -106,622 Annual.
About us
Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
About the role
Under the supervision of the Claims Manager, the Claims Supervisor will follow organization policies and KHS guidelines; and is responsible for supervising the functions of the day-to-day processing of first-time claims submissions, ensuring the timeliness and accuracy of claims payments.
This position is responsible for supervising the claims processing function for a Knox-Keene licensed health maintenance organization (HMO).
Essential Duties and Responsibilities
- Leads, trains, develop and evaluate assigned staff. Applies personnel policies and ensures the continual development of staff.
- Manages team production, workloads and priorities.
- Ensures team compliance and adherence to established team performance standards.
- Ensures timely performance measurement and assists in the identification and implementation of improvement initiatives.
- Acts as liaison to Provider Relations, Member Services and Utilization Management on claim issues.
- Researches and resolves provider claims issues as it relates to claims bill and payment issues.
- Responsible for reviewing and releasing high dollar claims, edits and clearing adjustments that the claims processors are not able to release.
- Reviews reports daily to manage claim inventory
- Manages any urgent issues from other areas to ensure that they are resolved in a timely manner.
- Claims point person for issues/concerns on claims related business from other departments, and external customers.
- Attend and participate in internal and external meetings regarding claims related business.
- Keep Manager and Director informed of any issues or concerns.
- Report system issues to the appropriate staff person for resolution.
- Provides support in updating and reviewing completed Claim Policies and Procedures.
- Completes monthly individual performance plan reviews and yearly performance appraisals for staff.
- Provides monthly report to management.
- Perform all other related duties as assigned.
Other Function
- Assist Director of Claims, Deputy Director of Claims, and Manager of Claims in completing claims related special projects.
- Performs other job-related duties as required
- Adheres to all company policies and procedures relative to employment and job responsibilities
Education and Experience:
Bachelor's degree in business administration or related field from an accredited institution or equivalent AND two (2) years of administrative or supervisory experience in a medical claim’s payment processing operation.
OR
Six (6) years’ experience in medical claims payment processing operation. And two (2) of those years must be supervisory or lead/senior level Claims payment processing position.
Health maintenance organization (HMO) claims payment-processing experience is highly desirable.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.
Salary : $83,625 - $106,622