Supervisor, Claims

American Benefit Plan Administrators, Inc.; San Francisco, Northern (CA, KY); Hybrid; USD 68,000 - 92,000; Full time

Job summary

Zenith American Solutions seeks a Supervisor, Claims in the Claims Department to lead a team through complex health and welfare claims processing in a Taft-Hartley setting. You will oversee workload, ensure quality, and maintain compliance with plans and regulatory requirements.

The role requires strong leadership, deep knowledge of claims adjudication, ICD-10/CPT-4 coding, and the ability to manage resources, train staff, and resolve issues across multiple clients.

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.

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.

Skills

Leadership

Process improvement

PHI/PII handling

ICD-10/CPT-4 codes

Communication

Problem solving

Microsoft Office

Claims adjudication

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Supervisor, Claims Department: Claims Bargaining Unit: NBU Grade: N/A Position Type: Exempt Hours per Week: 40

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.

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.

Compensation

$80,000/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! At Zenith American Solutions, we take immense pride in fostering a positive, respectful, and supportive work environment that provides challenging opportunities while supporting a healthy work/ life balance. Our organizational culture is founded on principles of integrity, honesty and respect for all stakeholders, including our employees, clients, and business partners. With a low employee turnover rate and a high rate of internal promotions and transfers, the Zenith team is proud to be a part of an 80-year legacy of excellence. Our employees embody a spirit of integrity, take immense pride in their work, and are enthusiastic about referring others to join our team.