UNITE HERE HEALTH

Claims Supervisor

US-IL-Aurora
2 weeks ago
ID
2017-1402
# of Openings
1
Category
Medical Claims
Company
UNITE HERE HEALTH

Overview

betterworkplaceuhh

 

 

Looking for a way to influence the health and healthcare of many?

 

If so, we’d love to hear from you! Our mission-driven organization is focused on theTriple Aim - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.

 

UNITE HERE HEALTH serves 100,000+ workers and 220,000 covered lives, in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

 

 

Key Attributes:

  • Integrity - Must be trustworthy and principled when faced with complex situations
  • Ability to build positive work relationships - Mutual trust and respect will be essential to the collaborative relationships required
  • Communication - Ability to generate concise, compelling, objective and data-driven reports Teamwork Working well with others is required in the Fund'ss collaborative environment
  • Diversity - Must be capable of working in a culturally diverse environment Continuous Learning Must be open to learning and skill development. As the Fund�s needs evolve, must be proactive about developing new areas of expertise.

 

Responsibilities

The Claims Supervisor will assist in directing, coordinating and controlling the processing, adjudication and payment of hospital, physician, dental, vision, disability, life, and / or other supplementary claims with specified responsibility, authority and accountability for assigned area.  The Claims Supervisor will also:

 

  • Assist in directing and controlling the timely processing/adjudication and expedites payment of hospital, physician and/or supplementary claims, and/or assists in directing and controlling key claim support functions including system support, plan building, quality assurance, training, provider maintenance, claim keying operations, clerical support, and assorted other functions
  • Assist in directing and controlling the timely processing of Local and member correspondence, telephone inquiries, adjustments and appeal payments
  • Assist in the development and implementation of operating procedures and utilization safeguards
  • Coordinate projects related to claim operations and procedures, insuring timely, accurate and cost effective completion of assignments
  • Coordinate and supervise the preparation of regular and special management reports and the completion of various claims studies and reviews for completeness and analysis
  • Assume the responsibility to determine and authorize exceptions to normal operating procedures when necessary
  • May assume responsibility for the operation of the department in the absence of the manager
  • Maintain technical knowledge of claims procedures
  • Issue verbal and / or written communications / correspondence, whether internal or external, as related to the claims area
  • Interface with other departments in the course of supervisory duties
  • Conduct employee evaluations including ongoing feedback and development of staff
  • Administer personnel policies and procedures fairly and consistently
  • Act in a problem solving capacity as related to internal or external issues
  • Maintain up-to-date knowledge of all factors including benefit plans, systems, policies, practices, decisions, etc. that affect the day-to-day operations of the Claims Department
  • Perform other duties as assigned within the scope of responsibilities and requirements of the job

Qualifications

  • Bachelor’s Degree in Business Administration 
  • Minimum of 4 years’ experience in a Health insurance administration environment
  • Experience in a Taft-Hartley and/or union environment desired
  • Prior supervisory experience is preferred
  • Must possess the required technical background/ability to train and supervise personnel assigned to the unit
  • Demonstrated technical knowledge of, and comfort with, claims processing systems, including process procedures, data tables and processing methodologies
  • Experience with and understanding of, claim and medical reference materials and manuals
  • Basic understanding and or exposure to health claim processing systems preferred
  • Minimum level computer skills in a Microsoft Office environment: Intermediate
  • Professional presentation and communication skills (written/verbal)
  • Interpersonal skills with the ability to work collaboratively with superiors, peers, and subordinates
  • Provide effective leadership and training to an assigned team or teams
  • Good organization and analytical skills, and a willingness and ability to pay close attention to detail are strongly desired

Ability to:

  • Be a positive and professional representative of the organization and interact well with all levels of staff across geographic regions
  • Demonstrate leadership skills and support and work in a team environment
  • Manage competing deadlines and multiple projects in a fast-paced environment
  • Perform the essential functions of this job with or without reasonable accommodation 

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