Supervisor, Claims

Molina Healthcare; Miami (FL); On-site; USD 45,000 - 89,000; Full time

Job summary

Molina Healthcare is seeking a senior claims supervisor to lead a team responsible for claims payments, records, and beneficiary guidance on coverage and benefits. This role monitors backlog and ensures timely settlements in line with cost-control standards.

The position requires coordinating daily workflow, hiring and mentoring staff, and driving process improvements across the claims department. Strong collaboration with leadership and cross-functional teams is essential.

Qualifications

• At least 5 years of medical claims processing experience.
• Thorough knowledge of outpatient and inpatient facility claims for Medicare, Medicaid, and Marketplace.
• Research, analysis, data entry, and auditing skills.
• Organizational skills and attention to detail.
• Time-management skills and ability to manage multiple projects and deadlines.
• Ability to work cross-collaboratively in a highly matrixed environment.
• Strong customer service experience.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software proficiency.

Responsibilities

• Coordinates workflow and staffing of day-to-day claims activities and assigns and monitors work of staff to meet productivity and quality standards.
• Hires, onboards, trains, supervises, and develops claims team and demonstrates accountability for team performance.
• Plans daily claims priorities and responds to new priorities and process-improvement opportunities.
• Executes claim handling strategies including determination of coverage, processing guidelines and metrics.
• Reviews and analyzes claim reports to identify trends and suggests corrective actions.
• Manages claims escalations with accountability, urgency, and closure.
• Documents recommendations for claim disposition including evaluation, negotiation and settlement within staff authority.
• Compiles and submits daily, weekly and monthly departmental claims reports to leadership.
• Collaborates with senior claims leadership to develop initiatives to improve efficiency.
• Completes claims projects as assigned.

Skills

Medical claims processing

Medicare/Medicaid claims

Research/Analysis

Data entry

Auditing

Time management

Communication

MS Office

Tools

MS Office

Job description

Job Summary

Leads and supervises team responsible for claims activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Also monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion and in accordance with cost-control standards.

• Coordinates workflow and staffing of day-to-day claims activities and assigns and monitors work of staff in order to adhere to productivity and quality standards.
• Hires, onboards, trains, supervises, and develops claims team, and demonstrates accountability for team performance.
• Proactively plans for daily claims priorities, and responds to new priorities and process improvement opportunities assigned by leadership.
• Ensures execution of claim handling strategies including appropriate determination of coverage, processing guidelines and metrics.
• Reviews and analyzes claim reports to identify and address trends; recommends strategies to correct adverse trends.
• Effectively manages claims escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
• Reviews and documents recommendations for claim disposition including evaluation, negotiation and settlement of claims in excess of staff authority levels.
• Compiles and submits daily, weekly and monthly departmental claims reports to leadership.
• In collaboration with senior claims leadership, develops claims department initiatives to improve overall efficiency.
• Completes claims projects as assigned.

• Remote and must live in Florida***

Job Description

Leads and supervises team responsible for claims activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Also monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion and in accordance with cost-control standards.

Essential Job Duties

• Coordinates workflow and staffing of day-to-day claims activities and assigns and monitors work of staff in order to adhere to productivity and quality standards.
• Hires, onboards, trains, supervises, and develops claims team, and demonstrates accountability for team performance.
• Proactively plans for daily claims priorities, and responds to new priorities and process improvement opportunities assigned by leadership.
• Ensures execution of claim handling strategies including appropriate determination of coverage, processing guidelines and metrics.
• Reviews and analyzes claim reports to identify and address trends; recommends strategies to correct adverse trends.
• Effectively manages claims escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
• Reviews and documents recommendations for claim disposition including evaluation, negotiation and settlement of claims in excess of staff authority levels.
• Compiles and submits daily, weekly and monthly departmental claims reports to leadership.
• In collaboration with senior claims leadership, develops claims department initiatives to improve overall efficiency.
• Completes claims projects as assigned.

Required Qualifications

• At least 5 years of medical claims processing experience, or equivalent combination of relevant education and experience.
• Thorough knowledge of processing outpatient and inpatient facility claims for Medicare, Medicaid, and Marketplace plans.
• Research, analysis, data entry, and auditing skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively in a highly matrixed environment.
• Strong customer service experience.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Management/leadership experience.

#PJClaims

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $45,390 - $88,511.46 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.