Supervisor, Claims

IMPORTANT: Please apply directly using the following link to be considered for this role.

https://app.jobvite.com/j?aj=okE0hfwZ&s=really

Founded in 1926, Western Growers represents local and regional family farmers growing fresh produce in Arizona, California, Colorado and New Mexico. Our members and their workers provide over half the nation's fresh fruits, vegetables and tree nuts. Some farm throughout the U.S. and other countries so people have year-round access to nutritious food. For generations, they provide variety and healthy choices to consumers. Connect with and learn about Western Growers on our Twitter and Facebook.

Western Growers Assurance Trust (WGAT) was founded in 1957 to provide a solution to a need in the agricultural community — a need for employer-sponsored health benefit plans not previously available from commercial health insurance carriers. WGAT is now the largest provider of health benefits for the agriculture industry. The sponsoring organization of WGAT is Western Growers Association, created in 1926 to support the business interests of employers in the agriculture industry. WGAT’s headquarters is located in Irvine, California.

WGAT’s mission is to deliver value to agriculture-based employer groups by offering robust health plans that meet the needs of a diverse workforce. By working at WGAT, you will join a dedicated team of employees who truly care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to WGAT today!

Job Description Summary

Position reports to the Manager, Claims. The Supervisor, Claims coaches, counsels, and trains staff and supporting roles in accordance with company policies. The Supervisor is responsible for promoting quality, superior customer service, and identifying enhancements, Electronic Data Interchange (EDI) activity accuracy, changes to workflows to increase effectiveness and productivity. This position will support Claims Team Leads, Claims Examiners and Auditors.
Qualifications

• BS/BA degree preferred, and a minimum of three (3) to five (5) years recent experience as a Supervisor of a medical/dental claims operation.
• Expert knowledge of medical claims processing with Health Maintenance Organization (HMO), Preferred Provider Organization(PPO), Exclusive provider Organization (EPO), Point of Service (POS), Consolidated Omnibus Budget Reconciliation Act (COBRA), Long Term Care, Life Insurance Plan, Reinsurance, Risk Based Models, Flexible Spending Account (FSA), Health Risk Assessment (HRA), Medicaid, Medicare, State/Federal payers, and experienced with both fully insured and self-insured benefit plans.
• Expert knowledge of Electronic Data Interchange (EDI) standardization, medical terminology, claims and billing information between vendors and payers.
• Excellent written and verbal communication skills – demonstrated effective and professional communication to both internal and external customers.
• Demonstrated ability to work collaboratively in a team environment, facilitate meetings, conduct training sessions, and support team decisions.
• Strong skills in multi-tasking, research, resolving processing and system issues, claim inventory, escalations, phone calls, and prioritization.
• Knowledge and understanding of the health insurance business, health products, ancillary products, work queue operations, Summary of Plan Description, Summary of Benefits and Coverage, National Correct Coding Initiative editing, National & Local Coverage Determinations from Centers for Medicare/ Medicaid Services (CMS), Health Insurance Portability and Accountability Act (HIPAA), Multiple Employer Welfare Act (MEWA), and Perspective Payment Systems reimbursement systems, and Employee Retirement Income Security Act (ERISA) regulations and compliance.
• Proficient knowledge of word processing, data evaluation, and spreadsheet end-user office software.
• Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 5% of the time.

Duties And Responsibilities

Administration

• Ensure that all administrative activities comply with laws, regulations, policies, agreements, and contractual arrangements.
• Responsible for technical support, research, document policy/procedures, electronic and paper claims interchange submissions; oversee analytics, correction, and resubmission of claims.
• Supervise staff in area of claims auditing, training, coaching and quality for Western Growers Assurance Trust and Pinnacle Claims Management Inc.
• Track and maintain Claim Audit department standards to insure compliance with the business operational and quality standards.

Process Improvements

• Continuous review and implementation of process improvements.
• Coordinate and schedule on-going training for staff.
• Train audit staff in department policies and procedures to maintain department and organizational standards and strategic objectives.
• Assist in developing examiner staff in claims processing standards, department policies and procedures to maintain department and organizational standards and strategic objectives.
• Develop guidelines capture the workflow processes for claims and audit.

Reporting

• Oversee the electronic data interchange process to ensure that no more than 3% reject to paper for each day’s receipts.
• Track and report production and quality measurements.
• Monitor, improve and track turn-around-time, EDI operations, efficiencies, performance guarantees and production.
• Prepare daily and weekly reports for the Manager, Claims.

Management & Leadership

• Develop, manage, and lead a team of 3A self-accountable professionals.
• Develop a culture of real, personal accountability by modeling the behavior that defines it.
• Instill a culture of safety and expectation, within your respective area/s.
• Require direct reports to hold themselves accountable to high standards of performance and personal conduct, in a clear, helpful, straightforward way.
• Conduct one-on-one conversations with every direct report, quarterly, focused on their 3A capabilities, impact, and effort.
• Make decisions and choices, impacting staff, by using the steps as outlined in the “Outward Mindset Skills for Leaders” guide.

Other

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
• Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 5% of the time.
• All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

IMPORTANT: Please apply directly using the following link to be considered for this role.

https://app.jobvite.com/j?aj=okE0hfwZ&s=really

Job Type: Full-time

Pay: $63,498.00 - $76,098.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Vision insurance

Schedule:

• Monday to Friday

Education:

• Associate (Preferred)

Work Location: One location