Claims Operations Supervisor

WellSense Health Plan; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

Join a growing health insurance company as a Claims Operations Supervisor. You will oversee claims staff, ensuring accurate processing and compliance with standards, while leading performance improvement initiatives. This full-time remote role offers competitive salaries and excellent benefits.

Benefits

Full-time remote work

Competitive salaries

Excellent benefits

Qualifications

• Minimum two years of claims and healthcare or managed care experience.
• Supervisory experience in claims operations preferred.

Responsibilities

• Monitor claims payment post-agreement to ensure accuracy.
• Supervise claims adjudicators and mailroom staff.
• Participate in audits and share resources within the claims team.

Skills

Strong communication

Process improvement

Project management

Attention to detail

Proofreading

Education

Bachelor’s Degree or equivalent experience

Tools

Microsoft Office

Job description

Join to apply for the Claims Operations Supervisor role at WellSense Health Plan.

It’s an exciting time to join WellSense, a growing regional health insurance company with a 25-year history of providing effective health coverage for members from all backgrounds.

Job Summary

The Claims Operations Supervisor oversees Claims staff responsible for processing claims across all Plan lines of business. The role ensures the availability of necessary tools and resources to meet or surpass contractual and internal metrics, proactively resolving service barriers related to claims handling, data entry, and quality.

Our Investment In You

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Responsibilities

• Monitor claims payment post-agreement to ensure accuracy
• Review paid claims data and quality feedback to identify systemic issues
• Coordinate with management on configuration and systemic payment issues
• Participate in or supervise claims testing and issue reporting
• Track claims aging and generate daily reports for management
• Collaborate on performance improvement plans with HR and management
• Supervise claims adjudicators and mailroom staff, ensuring productivity and quality, and troubleshoot issues with IT support
• Conduct performance appraisals and ensure compliance with standards
• Participate in audits and share resources within the claims team
• Maintain knowledge of benefits, provider networks, regulations, and policies

Supervision

• Supervises 10-15 staff members

Qualifications

• Bachelor’s Degree or equivalent experience
• At least two years of claims and healthcare or managed care experience

Preferred Skills and Attributes

• Supervisory experience in claims operations
• Strong communication, process improvement, and project management skills
• Proficiency in Microsoft Office, especially Excel
• Attention to detail and excellent proofreading skills

Working Conditions

• Reliable attendance required
• Primarily remote office environment
• Minimal physical effort and risk

About WellSense

WellSense serves over 740,000 members across Massachusetts and New Hampshire, offering Medicare, Medicaid, and individual plans. Committed to diversity and inclusion, WellSense participates in E-Verify and values equal employment opportunities.