Remote Claims Operations Lead

Allegheny Clinic; New York (NY); Remote; USD 58,000 - 90,000; Full time

Job summary

Highmark Inc. seeks a Senior Claims Supervisor to oversee day-to-day activities of claims processing units across markets, coordinating inquiries from members, providers, and account representatives. This role emphasizes supervision, workflow management, and process improvements.

The position covers NY state counties and requires at least a high school diploma and 2 years in a claims environment with 1 year supervising. Bachelor’s degree preferred.

Qualifications

• High School Diploma or GED required.
• 2 years experience in a claims environment.
• 1 year experience leading or supervising others.

Responsibilities

• Supervise day-to-day activities of claims processing units.
• Coordinate claim backlog distribution for regular and overtime work.
• Monitor and manage daily inventories to ensure staffing and resources.
• Serve as subject matter expert for benefit plans and claims processing issues.
• Research quality issues and respond to error assessments.
• Recommend and design process improvements to improve accuracy and timeliness.
• Handle other duties as assigned.

Skills

Processing systems

Claims processing methodologies

Regulatory interpretation

Highmark products

Education

Bachelor's degree

Job description

Highmark Inc. seeks a Senior Claims Supervisor to oversee day-to-day activities of claims processing units across markets, coordinating inquiries from members, providers, and account representatives. This role emphasizes supervision, workflow management, and process improvements.

The position covers NY state counties and requires at least a high school diploma and 2 years in a claims environment with 1 year supervising. Bachelor’s degree preferred.