Claims Supervisor
21 days ago
Chicago
Job DescriptionDescription: SEIU Healthcare IL Benefit Funds MEDICAL CLAIMS SUPERVISOR JOB DESCRIPTION JOB TITLE: Medical Claims Supervisor REPORTS TO: Medical Claims Manager DEPARTMENT: Medical Benefits & Claims POSITION TYPE: Salaried, Exempt BARGAINING UNIT: Non-Bargaining Unit SEIU Healthcare IL Benefit Funds is a dynamic healthcare organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. We serve over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with health and pension benefits. Our employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability through the alliance to each other, the organization and those we serve. Position Summary: The Claims Supervisor is responsible for overseeing the daily operations of the Claims staff. The Claims Supervisor leads the Claims staff by effectively applying technical competencies and leadership strategies to guide the team to ensure the daily operational expectations of the department are met or exceeded. The Claims Supervisor will be responsible for managing the staff in the areas of claims processing, clerical functions, and interdepartmental collaboration while ensuring performance standards, goals, and metrics are met or exceeded to satisfy participant and provider expectations under the Plan and contract terms. The Claims Supervisor has a high proficiency in both collaboration and independent work to ensure claims processing and communications are handled accurately and timely to meet Plan and contract guidelines. The Claims Supervisor will identify problems and oversee resolutions to ensure internal and external stakeholders, including plan participants, are serviced based on departmental goals. This position provides support and reports directly to the Medical Claims Manager and will work collaboratively with key leaders to carry out Claims Department operations. Requirements: Key Duties and Responsibilities: The Claims Supervisor will be responsible for the following: · Manages staff, demonstrating leadership qualities consistent with organizational vision, mission, values, and common agreements. · Effectively manage staff under a Collective Bargaining Agreement (CBA). · Reviews and approves staff time off requests and timecards. · Develops staff through performance management, goal setting, training and development, and effective employee relations. · Cultivates an environment of high morale, empowerment, and continuous improvement, innovation, and initiative. · Guide, coach, and mentor immediate direct reports in key functional areas including clerical support, claims processing, monitoring quality metrics, and interdepartmental processes and procedures. · Establishes and monitors key performance indicators (KPIs) to track growth and progress of department goals and objectives; and tracks the quality of work performed by employees in pursuit of goals and objectives. · Communicates professionally with leadership team, staff, as well as government agencies, unions, plan participants, attorneys, and consultants as directed by Claims Manager to develop effective working relationships. · Establishes, assigns, distributes, and monitors quality and quantity metrics of work while ensuring employees are held accountable for consistently meeting quality and production standards. · Ensures compliance and regulatory guidelines are adhered to, including but not limited to PPACA, CAA, NSA, Price Transparency Rules, DOL, ERISA, HIPAA, and other required guidelines. · Meet once a month at minimum with each direct report, and more frequently as needed, to build relationships and provide performance progress. · Oversee the maintenance of plan documents, including but not limited to plan descriptions, summary of material modifications, and summary of benefits and coverage. · Ensures the active operation and ongoing improvement of the benefits administration system to fully support the functions of the department. · Identifies issues and problems, develops solutions, and prepares recommendations, including development of policies and procedures. · Prepare and conduct staff annual performance reviews. Create and document policy and procedures to ensure consistency in claims operations · Maintains current knowledge of all health plans and department operations. · Triage and or resolve escalated inquiries from plan participants, unions, medical providers, or billers. · Performs other similar related duties and special projects as required. · Attend and participate in various meetings, including monthly All Staff meetings, department meetings, leadership meetings, training sessions, task force or other meetings as deemed appropriate to share, discuss, and solution for issues, as well as identify potential process improvements. · Create one-on-one (1:1) agendas using the Purpose, Outcome, and Process (POP) Model and keep thorough notes for each meeting. Privacy and Security Responsibilities: This position requires employee to handle Personal Identifiable Information (PII) and potentially Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officers. Education Requirements: · Bachelor's degree in business management, Healthcare Administration, or other relevant fields is required. · A master’s degree in business management, healthcare administration, or other relevant fields is preferred. · An equivalent combination of education, certification, training, and/or work experience may be used to meet the minimum education qualifications. Job Requirements: · Minimum of 10 years related field experience in medical insurance, medical claims or healthcare billing operations, provider relations operations, managed care, self-insured plans, non-profit, labor unions, benefits administration, or third-party administrator environment. · Minimum of three (3) years related supervisory experience, preferably in the relevant areas as mentioned above. · Demonstrated professional accountability and practiced use of self, with the commitment to manage, laterally, and to direct reports in a collaborative manner. · Proven ability to lead and motivate a team to balance staffing strength through growth and development. · Excellent verbal, written, and non-verbal communication and interpersonal skills, with the ability to actively listen and share insights at all levels of business, including effectively communicating with all stakeholders, including staff, leadership peers, executive team members, and external partners. · Strong decision-making and organizational skills, with the ability to optimize the use of all available resources to deliver to multiple priorities. · Demonstrated experience with medical claim and billing analysis, and benefits and claims system configuration. · Demonstrated knowledge and experience in the analysis and interpretation of provider contracts, including the ability to extract and analyze data and produce a meaningful conclusion. · Exceptional analytical and problem resolution skills; ability to exercise independent and sound judgment. · Knowledge and understanding of the health care industry, including in-depth medical claim processing, subrogation, pharmacy benefits, ICD-10 Diagnosis Codes, CPT Procedures Coding, HCPC Codes, HCFA 1500, and UB-02 claim forms. · Experience with desktop computers, laptop computers, printers, copiers, scanners, fax, and other office equipment. · Ability to organize and prioritize tasks. · Ability to demonstrate teamwork and work independently. · Strong time management capabilities and ability to meet deadlines. · Ability and willingness to assist in special projects and handle multiple tasks. Preferred Skills: · Prior multi-employer and Taft-Hartley trust fund experience strongly preferred. · Management of a hybrid remote workforce, in-person and remote. · Knowledge of the Fund’s benefits administration system (basys/Bridgeway) · Experience with project management software, such as Smartsheet. · Experience with virtual conference software (Teams and Zoom). · Experience with PowerPoint and Visio. · Internal and external awareness of social movements, labor movements, and political issues that impact work and the organization. Career Development & Continuing Education Opportunities: Yes Benefits: SEIU Healthcare IL Benefit Funds offers a comprehensive health benefit (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan. Diversity creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose. Salary range $65,000-$82,000