Claims Supervisor

Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement.

The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency.

Responsibilities Include:

• Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans
• Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
• Manages the inventory of claims against standard service level agreements (SLAs)
• Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement
• Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
• Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance
• Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems
• Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance
• Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades
• Performs other duties as deemed essential and necessary

Qualifications:

Required Skills and Abilities:

• Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims.
• Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team.
• Analytical Skills: Ability to analyze claims data and make informed decisions based on findings.
• Experience: Previous experience in claims processing or a related field, including supervisory experience.
• Understands health insurance benefit administration in a Self-Funded environment
• Ability to read and understand various forms, documentation, files, and information with the department.

Education and Experience:

• Candidate must have at least 3 years of experience with self-funded health care plans and processing in a TPA environment
• Candidate must have at least 3 years of experience supervising a claims team
• Candidates must have prior experience with a highly automated and integrated claim adjudication system
• Experience working with HealthRules Payer
• Understanding of health insurance benefits administration in a self-funded environment

Preferred Qualifications:

• Past Training Experience
• Experience working at TPA
• Experience with self-funded plans