Supervisor, Insurance Claims

Description

Purpose:
This position is responsible for the supervision of day-to-day operations for Document Process Specialist team of the Claims Intake, Verification, and Mail Services team, a critical operations department that acts as the primary intake unit for all of UPMC Health Plan paper claims and correspondence. This includes monitoring staff production and quality, identifying training needs, creating staff development programs, monitoring and maintaining acceptable inventory levels, providing support to TPA staff and team leaders; as well as measuring outcomes of employee development, efficient inventory management, individual and team performance against regulatory, compliance, and client service level agreements.

Responsibilities:

• Collaborate and create employee development programs that support job and career growth; align employee performance with department goals and objectives
• Ensure team members understand Client Service Level Agreements (SLAs), Performance Guarantees, Regulatory, and Compliance expectations; and align individual and team output accordingly; consistently communicate daily team goals and progress
• Effectively balance resources across multiple clients and team inventories to meet or exceed claim timeliness and quality goals
• Serve as a mentor to less experienced supervisory staff
• Meet deadlines and turnaround times set by management (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both)
• Strategize, plan, organize, and execute efficient inventory management
• Supervise and monitor ongoing performance of team members. Continually examine team performance against department standards. This includes employee recognition as well as timely, constructive, and helpful feedback
• Effectively monitor and track client and internal complaints/errors for training and process improvement opportunities
• Ensure the team promptly and thoroughly responds to sensitive/high-profile internal and client issues/complaints
• Serve as a role model in Strive for Excellence by supporting a positive work atmosphere, promoting quality outcomes that focus on a positive staff experience, and providing quality support services that are responsive to customer’s needs, proactive in scope, and accessible in nature
• Participate in interviewing, hiring, and training of team members; Enhance communication via effective team meetings, huddles, and employee one on ones; Partner with Internal Departments, Providers, Clients, and Management to make recommendations and improve operational performance
• Manage special projects
• Performs other duties as assigned

Qualifications

• Bachelor's degree in management, organizational leadership, health care, or other related field or equivalent work experience;
• Self-directed with a minimum of six years health insurance experience, with at least one year supervising an operation team; along with two years facilitating/coordinating the completion of tasks or projects via others;
• 3 years customer/client service experience strongly preferred;
• Experience in training, developing, and coaching staff;
• Excellent organizational, interpersonal, and written communication skills a must;
• Strong leadership skills and abilities; strong independent decision-making ability a must.
• Thorough knowledge of Commercial, Medicare and Medical Assistance programs required.
• Must be able to manage more than four varying operation production inventories simultaneously; while assisting in the resolution of high-profile client issues; Must be able to thrive in a fast-paced production environment;
• Project and process management skills strongly preferred;
• Competence in MS Office and PC skills required.

Licensure, Certifications, and Clearances:

• Act 34


• UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary : $29 - $49