Skills & Competencies for Claims Processing Supervisor - Healthcare

Claims Processing Supervisor - Healthcare job profile

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JOB SUMMARY for Claims Processing Supervisor - Healthcare

Supervises the administration of health insurance claims, payment processing, billing research, and responding to inquiries.

JOB RESPONSIBILITIES for Claims Processing Supervisor - Healthcare

Ensures the accurate and timely disposition of claims and resolves matters according to coverage amounts and company procedures. Provides guidance to staff on more complex or high-value claims. Reviews and resolves escalated issues.

Claims Processing Supervisor - Healthcare SALARY RANGE

BASE 50%
$73,371
TOTAL 50%
$76,520
Job Level
M00
Job Code
HC07000584
Education/Degree
High School Diploma or Technical Certificate
Reports To
Manager

Claims Processing Supervisor - Healthcare Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Claims Processing Supervisor - Healthcare skill and competencie below to view definitions.
INDUSTRY COMPETENCIES JOB FAMILY COMPETENCIES CORE COMPETENCIES
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8 hard skills or competencies (industry competencies) for Claims Processing Supervisor - Healthcare

1 Industry Competency – Insurance Industry
Proficiency Level -2
Skill definition-Applying knowledge of the insurance industry to provide risk management services and protection to various individuals from financial loss.
Level 1 Behaviors
(General Familiarity)
Cites different types of insurance policies and describes the advantages and disadvantages of each.
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Level 2 Behaviors
(Light Experience)
Compiles insurance quotes based on customer information and rates for insurance policies.
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Level 3 Behaviors
(Moderate Experience)
Examines insurance applications and letters from clients to determine necessary policy changes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates existing claims handling process to identify fraud and opportunities for optimization of outcomes.
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Level 5 Behaviors
(Mastery)
Champions the adoption of AI and automation technologies to streamline insurance operations.
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2 Industry Competency – Insurance Legal and Regulatory Environment
Proficiency Level -2
Skill definition-Creating, executing, and adhering to state and federal laws governing insurance operations to ensure financial security and consumer protection.
Level 1 Behaviors
(General Familiarity)
Cites examples of the legal principles of insurance applicable to multiple types of insurance products.
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Level 2 Behaviors
(Light Experience)
Assists in assessing regulatory risks to ensure insurance operations meet compliance and regulatory obligations.
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Level 3 Behaviors
(Moderate Experience)
Adopts legal and regulatory initiatives to assess possible risks and maintain insurance solvency.
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Level 4 Behaviors
(Extensive Experience)
Directs the regulation of insurance products to ensure insurance policy provisions comply with state laws.
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Level 5 Behaviors
(Mastery)
Builds policy and regulatory tools to monitor and assess compliance levels with insurance laws and regulations.
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3 Claims Processing Supervisor - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Processing Supervisor - Healthcare
Proficiency Level - 4
5 Competency for - Claims Processing Supervisor - Healthcare
Proficiency Level - 5

1 general skill or competency (Job family competency) for Claims Processing Supervisor - Healthcare

1 Job Family Competencies – Payment Processing
Proficiency Level -2
Skill definition-Completing transfer of funds from the transaction to the merchant's account.
Level 1 Behaviors
(General Familiarity)
Discusses various payment processing rules and regulations.
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Level 2 Behaviors
(Light Experience)
Enters relevant information into the system for accurate payment processing.
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Level 3 Behaviors
(Moderate Experience)
Performs the electronic payment processing of transactions for our business.
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Level 4 Behaviors
(Extensive Experience)
Ensures the accurate recording of relevant data for all payment processing transactions.
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Level 5 Behaviors
(Mastery)
Develops an organizational structure to manage the processing of invoices efficiently.
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3 Claims Processing Supervisor - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Processing Supervisor - Healthcare
Proficiency Level - 4
5 Competency for - Claims Processing Supervisor - Healthcare
Proficiency Level - 5

10 soft skills or competencies (core competencies) for Claims Processing Supervisor - Healthcare

1 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -2
Skill definition-A set of written instructions that describes the step-by-step activities to complete tasks in compliance with business standards and industry regulations.
Level 1 Behaviors
(General Familiarity)
Discusses the considerations and concerns on applying SOP for the first time.
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Level 2 Behaviors
(Light Experience)
Documents the SOP drafts and outlines for final approval.
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Level 3 Behaviors
(Moderate Experience)
Initiates SOP revisions to support continuous improvement of processes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates the benefits and drawbacks of a specific SOP; oversees the corresponding enhancements.
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Level 5 Behaviors
(Mastery)
Establishes formal policies and procedures to guide the our SOP practices.
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2 Core Competencies – Planning and Organizing
Proficiency Level -2
Skill definition-Managing and prioritizing resources and workloads by creating well-organized plans to attain organizational goals and objectives.
Level 1 Behaviors
(General Familiarity)
Documents best practices in planning and organizing work to address important tasks.
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Level 2 Behaviors
(Light Experience)
Discusses the positive and negative outcomes of planning and organization in the workplace.
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Level 3 Behaviors
(Moderate Experience)
Helps set up new practices to anticipate and address the needs of planning and organization initiatives.
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Level 4 Behaviors
(Extensive Experience)
Facilitates the adoption of advanced tools to streamline the process of planning and organization.
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Level 5 Behaviors
(Mastery)
Develops best practices in planning and organizing activities to improve organizational efficiency.
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3 Claims Processing Supervisor - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Processing Supervisor - Healthcare
Proficiency Level - 4
5 Competency for - Claims Processing Supervisor - Healthcare
Proficiency Level - 5

Summary of Claims Processing Supervisor - Healthcare skills and competencies

There are 8 hard skills for Claims Processing Supervisor - Healthcare, Insurance Industry, Insurance Legal and Regulatory Environment, Health Insurance, etc.
1 general skills for Claims Processing Supervisor - Healthcare, Payment Processing.
10 soft skills for Claims Processing Supervisor - Healthcare, Standard Operating Procedures (SOP), Planning and Organizing, Coordination, etc.
While the list totals 19 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Claims Processing Supervisor - Healthcare, he or she needs to be proficient in Standard Operating Procedures (SOP), be proficient in Planning and Organizing, and be proficient in Coordination.

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