Supervisor Claims Operations
Supervisor FEP Claim Operations
The Supervisor of Claims Operations supervises daily activities of specific market segment unit (FEP) and ensures accurate and timely processing of all claims and post payment adjustments. Oversees review of claims for benefit determination, other party and subscriber liability. Supervises examiners/analysts in providing prompt and accurate information and courteous service to all internal and external customers.
Responsibilities
- Plans, controls, coordinates daily workflow, maintaining high rate of quality and productivity without excessive overtime
- Supervises examiners/analysts in the accurate and timely processing of medical claims and all related procedures. Supervises processing of necessary adjustments on paid claims. Maintains an effective, on-going quality control program and ensures that all operational standards of performance established by the account, our Plan, Blue Cross and Blue Shield Association, etc., are met.
- Ensures that prompt, accurate information and courteous service is provided to all internal and external customers via all forms of communication.
- Prepares production reports for management. Maintains accurate and current records of all claims and inquiries received, processed, and pended.
- Reviews work procedures, work output and automated programs to detect problem areas and opportunities for improvement. Initiates and/or assists with projects and procedural changes affecting the specific workstream, including major system changes to maintain and enhance the efficient processing of claims. Makes recommendations and develops and implements new or revised methods or procedures.
- Monitors performance of subordinates, working to develop and enhance their skills. Administers corrective action in accordance with policy when appropriate.
- Performs other appropriate duties as assigned.
Qualifications
Education
· Undergraduate degree, preferably in Business Administration, in addition to a minimum of 3 years of supervisory experience. In lieu of the degree, a minimum of 5 years of similar leadership experience within an operations environment is required.
Experience
- 5 years FEP claims processing or related experience is required
- Prior experience should include a minimum of 2 years work leadership responsibility in claims or related operations
Knowledge, Skills, Abilities
- Required: Experience with FEP Claims Processing and FEPDirect
- Demonstrated ability in organizing and controlling workflows
- Proven understanding of COB/OPL coordination rules
- Excellent oral and written communication skills and the ability to complete assignments with minimal guidance.
- Strong Analytical ability to identify and resolve staff and customer problems.
- Must be able to prioritize work in an environment that changes frequently.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.