Description
Welcome to Montage Health's application process!
Job Description:
The Claims Supervisor will be responsible for oversight of the claims department, to include monitoring and auditing of the work performed by claims department staff. The Claims Supervisor will be responsible for ensuring that claims are processed according to the contractual claim processing timelines and plan benefit requirements of each client.
Responsibilities
Track and monitor all claims inventory; queue review and follow up.
Ensure appropriate staff coverage to meet contractual claims processing timelines.
Directly supervise the work and performance of staff assigned to the claims department; monitor production by on a weekly basis.
Counsel staff on performance in a responsive and timely manner.
Supervise the claims refund process to ensure that applicable timelines are met; review refunds appeals for final determination.
Assist clients, brokers and vendors with claims questions and concerns regarding coverage and claim handling through claim resolution.
Distribute network updates to appropriate staff, as applicable to client contracts.
Oversee the testing and production of quarterly fee schedule updates, as applicable to client contracts.
Participates in planning and implementing new groups and vendors.
Processing of Pharmacy Benefit Manager and Vision vendor invoices, as applicable to client contracts.
Assist analysts, as needed, with processing claims and/or provide training to new hires.
Performs other duties as assigned.
Position Requirements
Working knowledge of California regulation specific to the administration of Commercial HMO plans.
Working knowledge of federal regulation specific to the administration of self-funded employer health and welfare plans, including ERISA, Department of Labor and Health and Human Services.
Advanced knowledge of coding, billing and medical terminology.
Ability to operate spreadsheet, word processing programs and computer equipment required to fulfill position responsibilities.
Strong leadership and management skills.
Excellent organizational and interpersonal skills.
Exceptional diplomacy skills to effectively resolve issues under sometimes tense and stressful circumstances.
Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity.
Ability to use sound judgement, identify next steps to be taken, and develop appropriate solutions.
Ability to collaborate with multiple parties to solve problems.
Competencies
Accountability and Dependability: Assumes responsibility for accomplishing duties in an effective and timely manner.
Integrity: Consistently honors commitments and takes responsibility for actions and words.
Software and Computer Skills: Proficient in the use of Microsoft Office Suite, Highly skilled at using the Internet. Must learns effectively with computer-based and/or online training.
Flexibility: Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.
Inclusiveness: The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.
Skills and Education
Minimum 3 to 5 years experience in processing medical/dental claims.
Benefits Competitive benefit package
Salary $32-36, based on experience
Aspire Health Plan is an equal opportunity employer.
Assigned Work Hours:
M-F, 8am-5pm
Hybrid schedule. On-site one week a quarter, or as otherwise dictated by business needs.
Position Type:
Regular#SupportSvcs
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