Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. GENERAL PURPOSE OF JOB The Claims Supervisor is responsible for the daily oversight of the Claims Administration team, including productivity, quality, training, development, and coaching. The position responsibilities include claim inventory management, ensuring adherence with operational policies and procedures, coordination of benefits, claim quality audit, root cause analysis, claim appeals, claim adjustments, claim refunds, and continual process improvement. The position also provides technical and professional leadership to the department and serves as a subject matter expert to internal and external business partners, regarding claim adjudication policies and procedures. ESSENTIAL DUTIES AND RESPONSIBILITIES Positions in this class may perform any or all of the below listed duties. These should be interpreted as examples of the work, and are not necessarily all-inclusive. Provide supervision for the Claim Administration team, including but not limited to claim support activities including paper claim OCR scanning/verification and administrative support, claim processing, coordination of benefits, other insurance investigation, claim appeals, claim adjustments, claim refunds, claim quality audit, root cause analysis, process improvement, and issue resolution. Provide oversight of vendor relationships involving COB, Third Party Liability, and Subrogation. Ensure claims are managed and adjudicated in adherence with all applicable Federal, State, Contract, Compliance, and Regulatory requirements. Ensure the appropriate training, processes, workflows, and automated systems are in place to ensure claims are processed timely, efficiently, and accurately. Adjust staff assignments, direction, and priorities to quickly respond to changing business needs; ensure flexibility of the department through effective communication of business rationale, use of change management techniques, and setting a positive attitude example. Interface and collaborate with internal and external business partners to achieve resolution of claims issues and ensure the highest levels of provider satisfaction. Actively engage in root cause analysis of deficiencies and lead efforts in the development and implementation of effective remediation and process improvement solutions. Provide mentoring and coaching for Claims Administration staff to enhance understanding of departmental policies, procedures, and workflows and to provide opportunities for professional development and departmental bench strength. Provide leadership and oversight of claim cost containment efforts, including appropriate Contract, Benefit, and coding administration. Monitor appropriate Texas Medicaid resources (CMS, HHSC, TMHP, etc.) to continually ensure health plan adherence with State and Federal Texas Medicaid and CHIP benefits. Monitor and communicate performance goals and results to staff, engaging in appropriate coaching and development opportunities, and improvement action plans as needed. Supervise claim issue resolution process from identification to solution; ensure appropriate staff is assigned to resolve issues, ensure active collaboration with business partners as needed and ensure issues of high risk are communicated and escalated appropriately. Develop and maintain an environment that encourages teamwork and communication and supports quality and process improvement suggestions and solutions. Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Perform other related work as requested. SUPERVISORY RESPONSIBILITIES Effectively administers performance management system including: Developmental feedback, Goal setting, Assesses competency, and Progressive discipline. Strong knowledge of and effective in administering health system policies and procedures. Responsible for sound management of human resources. Makes and implements decisions compatible with organizational goals. Maintains composure, effectiveness, and flexibility under pressure. EDUCATION AND/OR EXPERIENCE Any combination of education and experience that would likely provide the required knowledge, skills, and abilities is qualifying. An Associate's degree preferred, or equivalent experience. Minimum five years professional experience in claims analysis and Coordination of Benefits, including order of benefit determination and payment calculation; experience with Texas Medicaid preferred. Minimum one year Supervisor experience, Medicaid experience preferred. Until all children are well. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.