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Centivo · 1 month ago

Claims Supervisor - Management Ancillary Support (CMAS)

United States

Full-time

Remote

Senior Level

$70K/yr - $80K/yr

5+ years exp

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. The Claims Supervisor will oversee the claim processing functions related to claims adjudication, appeals, escalations, quality, and recovery while managing a team to ensure accurate processing of healthcare claims for employer-sponsored health plans.

Health CareInformation TechnologyMedical

Responsibilities

Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans

Ensures that claims, appeals, and adjustments are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations

Manages the inventory of claims against standard service level agreements (SLA’s)

Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement

Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics

Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance

Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems

Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance

Liaison for the CMAS Team on various projects and/or initiatives including claims and testing needs to support system implementations and/or upgrades

Performs other duties as deemed essential and necessary

Qualification

Claims processingHealthcare claims administrationLeadership skillsAnalytical skillsBenefit administrationCommunication skillsOrganizational skillsCoaching skillsTechnical skillsResearch skillsRoot cause analysisMedical terminologyMS Office proficiencyProblem-solving skillsTeam managementAttention to detailFlexibility

Required

Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims

Strong leadership and team management skills, with the ability to effectively manage and motivate a team

Ability to analyze claims data and make informed decisions based on findings

Previous experience in claims processing or a related field, including supervisory experience

Understands health insurance benefit administration in a Self-Funded environment

Ability to read and understand various forms, documentation, files, and information with the department

High School diploma or GED required. Bachelor's degree or equivalent work experience

5 years or more experience with healthcare claims administration, self-funded preferred

Experience leading and delegating tasks to multiple direct reports

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

Must possess proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment

Proficient experience in MS Word, Excel, Outlook, and PowerPoint required

Candidates must have prior experience with a highly automated and integrated claim adjudication system

Preferred

Experience with member appeals, recovery processes, including NSA, subrogation and overpayment process, member, and/or client escalations

Ability to understand how, and to do thorough research, comfortable interviewing internal expertise and applying the 5 W's and/or other tools to complete root cause analysis

Ability to assimilate quickly to the organization or department's culture and speak in the voice of the brand; able to see the perspective of others and how to translate towards effective solutions

Ability to take complex issues and break them down so that it can be understood by others; ability to communicate with non-expert audiences

Strong knowledge of benefit plans, policies, and procedures, understanding of medical terminology

Strong technical and analytical skills