Supervisor Medical Claims

Job Summary

We are searching for a Claims Department Supervisor - someone who works well in a fast-paced setting. In this position, you will serve as a front-line supervisor by managing and directing the activities of a team of Claims Examiners and Claims Benefits Specialists. You'll also handle claims processing concerns and issues requiring a high degree of appropriate knowledge, creativity, research, and communication with internal and external resources to achieve timely resolution. You will ensure resources are utilized efficiently, in accordance with Claims Administration objectives that consistently promotes internal and external customer quality and satisfaction. In this position, you will also assist the Manager of the Claims Department by monitoring the daily workflow for team members in reference to claim volume, receipts and processing along with acting as a communication conduit between the Claims Examiners, Claims Benefits Specialists, and management.

Think you've got what it takes?

Responsibilities

• Provide direct supervision of the daily operations for Claims Examiners and Claims Benefits Specialists
• Provide daily monitoring for Claims Examiners and Claims Benefits Specialists production stats
• Provide front line questioning/answer and research
• Respond to a claims processing question rapidly and accurately in order to meet the Claims Examiners and Claims Benefits Specialists expectations of timely processing of claims in queue via email or discussion
• Resolve all questions on a daily basis accurately with a result of no pended claims or penalties
• Monitor and audit specified criteria based on claims training to assure perception of policy and procedures guidelines was comprehended
• Coordinate with trainer/manager a resolution to problems identified post training where a comprehension gap can be diminished
• Assist Manager in identifying opportunities for process and service improvement initiatives
• Participate in the development and implementation of action plans
• Compile and review Internal reports to identify any incorrect claims payment for all product lines for the weekly check run

Qualifications

• Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children's, unless approved for a medical or religious exemption.

• High school diploma or GED required
• 5 years' experience in claims processing required

Company Profile

Texas Children's Health Plan

The Texas Children's Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health. Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women. We are an Integrated Community System providing holistic care that empowers families to live healthier lives.

Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals.

To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org At Texas Children's Hospital, diversity, equity, and inclusion are at the core of our values and mission for the women and children that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.