Supervisor Claims

Allegheny Clinic; New York (NY); Remote; USD 58.000 - 90.000; Vollzeit

Zusammenfassung

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.

Qualifikationen

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

Aufgaben

• 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.

Kenntnisse

Processing systems

Claims processing methodologies

Regulatory interpretation

Highmark products

Ausbildung

Bachelor's degree

Jobbeschreibung

Company

Highmark Inc.

Job Summary

This job supervises and coordinates the day to day activities of the various claims processing or claims adjustment units responding to internal inquiries or inquiries received by members, providers, or account representatives across all markets.

Essential Responsibilities

• Communicate effectively.
• Effectively supervise all assigned personnel.
• Coordinate any claim backlog distribution for regular and overtime work both interdepartmentally and companywide.
• Monitor and manage daily inventories to ensure adequate staffing and resources are available.
• Subject matter expert for benefit plan and claims processing issues, implementation of new groups and products, and transition meetings.
• Research quality issues and respond to error assessments.
• Ensure all business processes are routinely monitored. Recommend and design, if necessary, process improvements designed to improve accuracy, timeliness of process and/or eliminate manual effort.
• Other duties as assigned or requested.

Location

This positions supervises employees mostly in the State of New York: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming counites.

Required

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

Preferred

• Bachelor's degree

Skills

• Knowledge of multiple processing systems and workflows
• Knowledge of claims processing methodologies
• Ability to interpret all government regulations.
• Knowledge of Highmark products.

Travel Requirements

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

• Position Type
• Remote Office-based
• Teaches / trains others regularly
• Occasionally
• Travel regularly from the office to various work sites or from site-to-site
• Rarely
• Works primarily out-of-the office selling products/services (sales employees)
• Never
• Physical work site required
• Yes
• Lifting: up to 10 pounds
• Constantly
• Lifting: 10 to 25 pounds
• Occasionally
• Lifting: 25 to 50 pounds
• Rarely

Pay Range

Pay Range Minimum: $58,100.00

Pay Range Maximum: $90,000.00

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

EEO Statement

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.