Supervisor, Claims

Zenith American Solutions, Inc.; San Francisco (CA); On-site; USD 81,000 - 99,000; Full time

Job summary

Zenith American Solutions, Inc. seeks a Supervisor, Claims in San Francisco to lead a claims team within a regulated, client-focused environment.

The role requires ensuring adherence to company guidelines, client needs, and regulatory requirements while providing daily supervision and staff development. The ideal candidate has extensive experience processing complex health and welfare claims, strong leadership, and the ability to optimize workflows.

Qualifications

• High school diploma or GED.
• Four years of experience processing complex health and welfare claims in a third-party administrator.
• One year of experience in a lead or supervisory role.
• Advanced knowledge of benefits claims adjudication principles and ICD-10 and CPT-4 codes.
• Strong communication and organizational skills; ability to manage multiple priorities.

Responsibilities

• Provide daily leadership and supervision to staff.
• Assign, monitor, and ensure quality and production standards.
• Develop staff through performance management and training.
• Maintain knowledge of plans and ensure processing compliance.
• Optimize workflows and staff allocation for efficiency.
• Handle complex or large-dollar claims and third-party recovery investigations.
• Prepare documents for external audits.
• Develop departmental SOPs.
• Perform other duties as assigned.

Skills

Leadership

Claims processing

Communication

Problem solving

Microsoft Office

Regulatory compliance

Team supervision

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Title: Supervisor, Claims Department: Claims

Bargaining Unit: NBU Grade: N/A

Position Type: Exempt Hours per Week: 40

Position Summary

The Supervisor, Claims provides daily leadership and supervision to a Claims team in accordance with Company guidelines, client needs, and regulatory requirements.

\"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role.\"

Key Duties And Responsibilities

• Provides daily leadership and supervision to staff consistent with Company values and mission.
• Assigns, distributes, and monitors quality and quantity of work produced, ensuring employees are held accountable for consistently meeting quality and production requirements.
• Develops staff through performance management, goal setting, training, and effective employee relations.
• Maintains current knowledge of assigned Plan(s) and effectively applies knowledge; provides oversight of processing activities to ensure compliance.
• Optimizes workflows/processes, tools, and staff allocation to ensure efficient and cost-effective day to day operations.
• Troubleshoots customer/client service issues and assists in the successful implementation of new clients.
• Reviews and interprets new benefits plans or changes/updates to existing plans; tests benefits for validation and accuracy. Develops and distributes resource documents as needed.
• Based on location needs, may provide advanced technical review and support of claims processing.
• • Provide technical review of all types of claims including large dollar and complex claims to validate benefit allowance and category.
  • Investigate, evaluate, and report on advanced cases for third-party recovery including stop-loss, accident, medical malpractice, subrogation, and Worker's Compensation.
• Compiles documents, records, and data for external audits, as requested.
• Assists in the development and documentation of departmental SOP's.
• Performs other duties as assigned.

Minimum Qualifications

• High school diploma or GED.
• Four years of experience processing complex health and welfare claims in a third-party administrator.
• One year of experience in a lead or supervisory role.
• Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes.
• Thorough knowledge of claims operations to include payment of claims, interpretation of contracts, communication of benefits, etc.
• Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Ability to communicate clearly and professionally, both verbally and in writing.
• Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities.
• Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment.
• Computer proficiency including Microsoft Office tools and applications.

Preferred Qualifications

• Experience working in a multi-employer or Taft-Hartley environment.
• Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Working Conditions/Physical Effort

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at [e-mail] , and we would be happy to assist you.

Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location.

Compensation

Compensation: $90,000/annually

Zenith American Solutions

Real People. Real Solutions. National Reach. Local Expertise.

We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before.

We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American!

We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!