The Claims Supervisor coaches, counsels, and trains a staff of claims analysts and supporting roles in accordance with company policies and applicable labor laws. The Supervisor is responsible for promoting quality, superior customer service, and identifying enhancements and changes to workflows to increase effectiveness and productivity. Provides on-going feedback on what is going well and areas for improvement/growth. Must be able to make independent decisions, multi-task and prioritize tasks, and with other internal departments to meet company goals.

Key Qualifications and Experience

Possesses strong/broad experience in medical claims processing. Experience in medical/dental terminology, CPT coding, ICD -10 coding, and ADA dental coding. Demonstrates an effective communication and presentation style (both written and verbal). Understands Self-Funding and Third-Party Administrating concepts and how decision making impacts the “big picture”. Is considered a resource for others as it relates to claims questions and problem-solving (Previous experience in a formal or informal leadership role desired).

Demonstrates ability to work and problem-solve independently --- has taken initiative to research and resolve processing and system issues using available resources and without waiting for direction. Views obstacles encountered as opportunities for improvement and offers ideas and solutions.

Possesses superior Customer Service skills --- seeks to understand expectations of internal and external customers. Knows which questions to ask and what information to verify to get to the root cause of a problem. Outlines options and presents unfavorable information in a manner that demonstrates empathy, is supported by SPD, and reflects a willingness to go the extra mile.

Possesses excellent verbal and written communication skills --- has demonstrated the ability to effectively and professionally communicate information to both internal and external customers. This includes facilitating meetings, conducting training sessions, organizing and documenting workflows and processes, handling escalated calls, and /or responding to appeals.

Respected by co-workers --- is able to focus on performance and behavior, rather than personality in relating to others and in resolving conflicts/issues. Actively listens and considers all perspectives prior to decision-making or addressing issues. Encourages and helps foster an environment of trust and mutual respect. Constructively addresses issues and holds co-workers accountable. Provides peers with direct and constructive feedback in a positive and professional manner.

Results orientated – understands where tasks and assignments fall into the big picture and organizes and prioritizes accordingly. Diligently follow-ups with Leadership, peers, other departments, and customers.  

Essential duties and Responsibilities

  • Report to work during core business hours (8:00 a.m.-5:00 p.m.) on a consistent, regular basis. Ensures work responsibilities are covered when absent. Arrives to meetings and appointments on time.
  • Provide full-time support as a technical resource for Claims, other departments, Vendors, and Customers during core business hours on a consistent, regular basis.
  • Collaborate with Plan Build, Sales, and Compliance to assure plans are built and administered to client specification
  • Provide training support for new employees and existing staff -- may have a group assigned to stay in touch with processing workflows and procedures  
  • Research, develop, document, and present policies and procedures.
  • Facilitate Appeals discussions and send appropriate correspondence, when required
  • Work with members of staff on identifying training needs
  • Maintain and update accumulators for new clients; work with Planbuild
  • and Sales to ensure appropriate reports are received for new groups
  • Create and Maintain claims spreadsheets / reference tools for staff
  • Process Large Dollar Claims.
  • Monitor inventories and ensure that high dollar claims and end of contract reimbursements are managed as a priority
  • Monitor phone queues and ensure proper coverage and adherence to schedules
  • Coach and counsel employees to meet and exceed quality, customer service, and productivity standards; remove obstacles preventing individuals from meeting goals
  • Perform audits as needed.
  • Perform regular individual and team meetings and complete annual evaluations
  • Provide a positive, stable, and consistent presence on the floor.
  • Coordinate interviewing, hiring, and development of new hires to department.
  • Address and document performance issues; coach or discipline employees as necessary.
  • Handle and resolve escalated phone calls/issues.
  • Identify, resolve, or escalate training, guideline, overpayment, and/or SPD interpretation issues
  • Maintain adequate staffing through management of staffing schedules and management of claims inventories
  • Ensures and maintains department quality and turnaround time standards
  • Evaluate and enter reporting data as needed
  • Perform other duties as assigned by management.

Equal Employment Opportunity Policy Statement

Lucent Health Solutions, Inc. is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.