Supervisor, Claims Analyst

Summary/Position Objectives:
Reports to the Claims Manager. This position manages Claims Analyst personnel to ensure performance and compliance for the Claims Department of Schaller Anderson of Arizona LLC. Incumbent manages a personnel base of up to 15 employees. Incumbent is responsible to ensure Claims Analysts achieve optimum accuracy, efficiency, and productivity targets in claims administration and adjudication. Incumbent manages and monitors the performance of Claims Analysts, ensures compliance with Schaller Anderson policies, procedures, and standards, and maintains all statistics for management reporting related to claims adjudication.

Responsibilities:
Essential Functions:
Manage Mass Adjudication, daily process and verification
Monitor Claims Analyst performance, productivity, accuracy, and compliance by measurement systems and benchmarking; reward and reprimand as necessary
Manage day-to-day workflow of Claims Analyst Team; manage paid time off (PTO) requests to ensure balanced work production within the team; verify time sheets
Serve as a mentor for questions regarding correct adjudication process, plan benefits, and company policies and procedures
Conduct personnel duties of the team in cooperation with the Director of Claims and the Human Resource Department, including applicant interviews, recommendations for hiring/terminations, employee evaluations, and employee training
Monitor and manage Stop Loss claims according to the line of business and carrier guidelines
Review claims related reports to ensure compliance with established standards and procedures
Identify, document, and report potential fraud, abuse, and misuse of medical resources
Support development of new business, policies, training, and desktop procedures
Assist the Health Plans with claims issues

Secondary Functions:
Develop, establish, and maintain a work priority system to ensure daily and heavy workloads are fulfilled
Maintain strict confidentiality in regards to all member, provider, and contract service information, including provider Federal Tax ID numbers, DEA numbers, and credentialing information
Assist with all issues as delegated by the Claims Manager or Claims Director
Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
Must maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs. (If travel required.)
REQUIREMENTS
Knowledge and Skills:
Incumbent must have skills in management and problem-solving, the ability to write correspondence, procedures and policies, schedules, and supporting documentation, the ability to use reason to define problems, collect data, establish fact, draw valid conclusions, and manage appropriate action plans, and the ability to establish and maintain constructive relationships with diverse management and employees. Incumbent must have advanced and meticulous organizational and coordination skills, and be able to handle multiple priorities. Incumbent must be able to successfully utilize Microsoft Office suite and common computer and office hardware. This position needs demonstrated skills in counseling, planning, training, and managing various staffing patterns.

Education and Work Experience:
High school diploma required. Incumbent must have at least three (3) years work experience in claims processing, with at least one (1) of those years as a Team Lead or in a supervisory role. Demonstrated experience in health plan operations, and call-center management preferred. Experience with Medicaid, Medicare, Self-funded and Commercial Ins. programs as relating to claims administration preferred. Advanced interpersonal skills, maturity, and good judgment are required. Working experience with QMACS™ managed health care software is required. This position requires work experience in a complex, competitive environment with diverse racial and socioeconomic factors.

Work Environment Qualifications:
Position is a computer station, office environment. May be required to sit for extended periods, entering and manipulating data on a workstation computer and participating in staff and executive meetings. Is required to have written and verbal communication ability, and generate written work, based on perceptive, verbally communicated contact. This position is required to work efficiently under significant time and deadline pressures. Spends at least 50% of daily responsibilities working both one-on-one and in teams with other personnel and executive management. Will have extended one-on-one contact with other employees in a quiet environment where hearing and listening is paramount. Position is a supervisory role; therefore, incumbent must possess comprehension, perception, and negotiation abilities.