Claims Supervisor

Texas Children's; Bellaire (TX); On-site; USD 65,000 - 85,000; Full time

Job summary

Texas Children's is seeking a Claims Supervisor to lead a team of Claims Examiners and Claims Benefits Specialists in an environment guided by HEART values. The role focuses on timely resolution of complex claims issues through leadership, coaching, and performance monitoring.

You will manage daily workflows, review production metrics, and drive improvements across claims processing to ensure accuracy and efficiency in claims handling.

Qualifications

• High school diploma or GED is required.
• Minimum 5 years of claims processing experience.

Responsibilities

• Proactively identifies and solves problems with timely resolution of complex issues referred by Claims Examiners and Claims Benefits Specialists
• Provides daily management support to Claims Examiners and Claims Benefits Specialists
• Obtains daily stats of each team member's production goals to review with Manager, and develops a plan to increase production while maintaining accuracy
• Responds to a claims processing question rapidly and accurately to meet expectations of timely processing of claims in queue via email or discussion
• Monitors and audits criteria based on claims training to ensure understanding of policy and procedures
• Assists the Manager with conducting performance reviews and team meetings
• Identifies opportunities for process and service improvement initiatives and participates in action plan development and implementation
• Compiles and reviews internal reports to identify any incorrect claims payment for all product lines for weekly check run
• Serves as initial point of contact for all issues regarding work schedules

Education

High school diploma or GED

Job description

At our company, our mission starts with our people. Guided by our HEART values of Humility, Excellence, Accountability, Respect, and Trust, we strive to create a workplace where teammates feel valued, supported, and empowered to do their best work every day.

As a Claims Supervisor, you'll manage and direct the activities of a team of Claims Examiners and Claims Benefits, and handle claims processing concerns and issues requiring a high degree of appropriate knowledge, creativity, research and communication with internal and external resources to achieve timely resolution.

Job Duties & Responsibilities

• Proactively identifies and solves problems with timely resolution of complex issues referred by Claims Examiners and Claims Benefits Specialists
• Provides daily management support to Claims Examiners and Claims Benefits Specialists
• Obtains daily stats of each team member's production goals to review with Manager, and develops a successful plan to increase each team member's production while maintaining accuracy
• Responds to a claims processing question rapidly and accurately to meet the Claims Examiners and Claims Benefits Specialists expectations of timely processing of claims in queue via email or discussion. Resolves all questions on a daily basis accurately with a result of no pending claims or penalties
• Monitors and audits specified criteria based on claims training to assure perception of policy and procedures guidelines was comprehended. Coordinates with trainer/manager a resolution to problems identified post training where a comprehension gap can be diminished
• Assists the Manager with conducting performance reviews and team meetings
• Assists Manager in identifying opportunities for process and service improvement initiatives, and participates in the development and implementation of action plans
• Compiles and reviews Internal reports to identify any incorrect claims payment for all product lines for the weekly check run. Completes actual check review process and forwards for check process on same day as check push every week
• Serves as initial point of contact for all issues regarding work schedules

Qualifications

• High school diploma or GED required
• 5 years of claims processing experience required