SHP Claims Review Team Leader
Marshfield Clinic - Marshfield, WI

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This position is responsible to have working knowledge of all aspects of claim processing and be familiar with responsibilities of the other departments within Security Health Plan. The Team Leader will assist the Manager in day-to-day duties and overall operations of the department, as well as performing supervisory duties as assigned. The Team Leader will be utilized as a resource for any questions, problems or more complex issues. This position is responsible for assisting with employee evaluations and disciplinary issues. The position also ensures quality work of team members by identifying deficiencies in training and recommending courses of action. The Team Leader is required to keep team members informed of any information from meetings, seminars, communications or publications, within or outside Security Health Plan. Provides the department with expertise in software programs and designs and revises departmental databases, edits and other I.S. Programs.

Job Qualifications:

Education: High School Graduate with nine to twelve months of added college or technical school training required; applicable experience may be substituted. Course of study should have emphasis on business or medical or experience in a claims environment. (Education qualifications must be from a school whose accreditation is recognized by Marshfield Clinic).

Must continue with educational opportunities in accordance with Marshfield Clinic policy, in topics relevant to the position based on Manager approval and business needs; preferably in the health insurance industry. Required to attend Supervisory/Human Resources classes or other seminars regarding the legal aspects of supervising a team.

Experience: Five years experience in a health insurance setting is required. Previous experience in claims processing also required. Must have Information Systems knowledge of insurance claim processes. Previous HMO, insurance or healthcare experience is required. Excellent oral and written communication skills required. Experience in Medical Terminology, CPT coding/HCPCS, ICD-9 coding and Anatomy & Physiology is required. Intermediate/Advanced level of knowledge of Microsoft Word and Excel and knowledge of Access and IT process required. One to two years supervisory and training experience preferred. Minimum of two years prior experience working collaboratively with IT professionals also preferred.

Exclusion from Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Clinic’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program. Information Systems knowledge of insurance claim processes required.

**You may submit your Cover Letter and Resume along with the online employment application. After submitting your application, you will be prompted to upload a Microsoft Word -OR- PDF version of your Cover Letter and Resume.**

Marshfield Clinic - 2 years ago - save job
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