Supervisor of Claims (Health Plans)

Samaritan Health Services; United States; Remote; USD 40,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Claims Processing Supervisor to lead their Claims Processing Department. This remote position offers the opportunity to manage a team while ensuring compliance with operational standards. Ideal candidates will have a strong background in claims adjudication and benefits analysis, along with proven leadership skills. Join a mission-driven organization focused on building healthier communities, and make a significant impact in the healthcare sector. If you are ready to inspire and guide a team towards achieving excellence, this role is for you.

Qualifications

• 4 years experience in claims-related roles required.
• 2 years leadership experience required.

Responsibilities

• Supervise the Claims Processing Department and mail room.
• Ensure compliance with operational benchmarks.

Skills

Claims Adjudication

Benefits Analysis

Leadership

Communication Skills

Problem Solving

Education

High School Diploma or equivalent

Job description

Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

Candidates residing out of state will need to be able to work Pacific Time Zone hours.

This is a remote position in which we are able to employ in the following states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin.

Job Summary/Purpose

• Responsible for the organization and supervision of the Claims Processing Department and mail room for Samaritan Health Plans (SHP). Provides leadership in setting and maintaining standards for the management of the department, ensuring compliance to the operational benchmarks established by department leadership.

Experience/Education/Qualifications

• High School Diploma or equivalent required.
• Four (4) years experience in a claims related role requiring claims adjudication, benefits analysis, coordination of benefits and/or third-party payer liability required.
• Two (2) years leadership experience required.
• Prior Claims Supervisor experience strongly preferred.

Knowledge/Skills/Abilities

• Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
• Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
• Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.

Physical Demands

• Rarely (1 - 10% of the time)
• Occasionally (11 - 33% of the time)
• Frequently (34 - 66% of the time)
• Continually (67 – 100% of the time)
• Climb stairs, lift and carry objects up to 20 lbs, bend, kneel, stand, walk, reach, push, pull, sit, manual dexterity, finger dexterity, pinch, grasp, and rotate trunk as specified.