American Specialty Health, Inc. is looking for an upbeat and results-driven supervisor for our Claims team. This position provides supervisory support for claims personnel, oversees claims processing and related tasks to meet deadlines. Related tasks include quality assurance and audit support (coordinate, monitor and support regulatory agency audits). The ideal candidate will ensure accuracy through identification of training needs and subsequent execution, and by monitoring the research and resolution of claims issues and errors.
· Monitors and documents individual and team performance; provides timely feedback, coaches and counsels; writes and delivers performance evaluations.
· Oversees daily operations and assigns work to staff members, including but not limited to the processing of ASO/OOS/special circumstance claims and/or notification processes.
· Informs manager of urgent issues, priorities, identified problems and associated recommendations.
· Evaluates staffing and resource needs, makes recommendations, and actively participates in the recruitment process.
· Maintains confidentiality of all members, practitioners, client and other proprietary and sensitive business information.
· Ensures claims compliance with regulatory agencies, accreditation agencies and health plan delegation requirements.
· Provides general assistance to department management in the implementation of quality improvement measures associated with audit results from regulatory agencies.
· AA degree or equivalent preferred.
· Production environment knowledge/experience required.
· Minimum of two years experience in a managed care claims department preferred, with at least one years as a claims examiner and an additional year of experience as a claims analyst, claims auditor or claims supervisor.
· Three years computer experience including automated claims systems, Microsoft Office (Word, Excel, Outlook), 10-key and typing skills.
· Minimum of one year supervisory experience or leadership capacity.
· Strong knowledge of HCFA and DOC claim requirements, CPT codes, ICD-9 codes and medical terminology preferred.
· Familiarity with Specialty Health Care, HMO, PPO health plan provisions.
· Strong analytical, problem solving, verbal and written communication skills.
· Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
· Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
· Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
· Ability to effectively organize, prioritize, multi-task and manage time.
· Demonstrated accuracy and productivity in a changing environment with constant interruptions.
· Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
· Ability to exercise strict confidentiality in all matters.
Primarily sedentary, able to sit for long periods of time.
Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Usual office setting.
ASH is an Equal Opportunity Employer. We encourage minorities, females, veterans and individuals with disabilities to apply.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans. Please view Equal Employment Opportunity Posters provided by OFCCP here .
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.