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%
$71,277
TOTAL 50%
$74,341
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)
Explains the policy conditions of various insurance contracts and products.
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Level 2 Behaviors
(Light Experience)
Provides prompt responses to clients’ insurance-related questions and concerns.
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Level 3 Behaviors
(Moderate Experience)
Reviews and analyzes claim applications to determine coverage eligibility and rates.
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Level 4 Behaviors
(Extensive Experience)
Monitors market trends in insurance services to deliver improved business impacts.
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Level 5 Behaviors
(Mastery)
Establishes and enforces standards for handling claims to maximize insurance workflow efficiency.
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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)
Discusses the importance of insurance regulations in protecting clients' financial security and assets.
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Level 2 Behaviors
(Light Experience)
Gathers and interprets policy contracts to understand insurance legal and regulatory standards.
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Level 3 Behaviors
(Moderate Experience)
Maintains financial and market regulation to validate insurance's accounting methods and procedures.
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Level 4 Behaviors
(Extensive Experience)
Sets guidelines to promote fairness and transparency in financial markets in providing insurance products.
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Level 5 Behaviors
(Mastery)
Develops compliance and risk management standards to manage overall insurance legal and regulatory environment.
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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)
Explains the essential payment processing terms to clients and the staff.
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Level 2 Behaviors
(Light Experience)
Receives invoices from vendors for payment processing.
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Level 3 Behaviors
(Moderate Experience)
Provides technical information for procedures related to payment processing.
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Level 4 Behaviors
(Extensive Experience)
Manages the payment processing tasks for our business.
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Level 5 Behaviors
(Mastery)
Establishes and implements controls for the payment processing team.
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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)
Identifies our internal and external sources for the SOPs we need.
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Level 2 Behaviors
(Light Experience)
Gathers information on workflows and business controlling points.
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Level 3 Behaviors
(Moderate Experience)
Maintains the accuracy of SOPs to provide consistent guidance in our workplace.
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Level 4 Behaviors
(Extensive Experience)
Leverages the use of SOPs to solve business and operation problems.
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Level 5 Behaviors
(Mastery)
Keeps abreast of industry regulation and its effect on our internal SOPs.
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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)
Explains the importance of planning and organization in building a good working environment.
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Level 2 Behaviors
(Light Experience)
Identifies key implications of ineffective planning and organization that affects decision-making.
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Level 3 Behaviors
(Moderate Experience)
Leverages key performance indicators to measure progress completion against performance metrics.
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Level 4 Behaviors
(Extensive Experience)
Manages the planning and sequencing of activities to create well-planned schedules and achieve goals on time.
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Level 5 Behaviors
(Mastery)
Establishes standards for planning and organization processes to align efforts with business goals.
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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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