Lead the activities necessary to process entry to intermediate claim queues, while achieving superior operational performance and process excellence. Accountable for all claim queue management ensuring contracted claim processing turn around times are met enterprise wide.
JOB DUTIES AND RESPONSIBILITIES:
Monitor daily and monthly turnaround times in all queues to ensure compliance with enterprise wide client contract requirements regarding claim processing.
Lead the timely, accurate, and efficient processing of the entry and intermediate claim queues.
Collaborate with cross functional leaders to ensure all claims are processed appropriately.
Manage daily forecast to ensure proper utilization of labor and overtime to achieve the maximum service levels within budget.
Develop staff measurements for Claim Processors and ensure all department production standards are met.
Provide consistent and effective leadership to claim processors building and maintaining a high performing team.
Assist with budget preparation on a monthly and annual basis.
Ensure performance and productivity of team is measured regularly and appropriate reward, recognition, or development is provided to team members.
Meet and communicate with clients, providers, members, and internal leadership to resolve daily issues.
Solution escalated claim payment & processing challenges from all constituents
Initiate and recommend necessary policies and procedures to Claims Director to ensure compliance and continuous improvement
Identify efficiencies and improve workflow and efficiencies in department.
Identify enhancements to current system platform to gain efficiencies.
Implementation and supervision of ongoing training program for all new and existing team members in the department.
Assist in the hiring process, including interviewing candidates, designing job descriptions, drafting advertisements, and promoting the organization to external applicants.
Complete all employee management duties, including but not limited to: hiring, training, terminations, corrective active plans, reward and recognition, preparation and presentation of performance evaluations assuring compliance with DentaQuest’s policies creating an environment of performance and operational excellence.
Conduct daily, weekly, and/or monthly staff meetings.
Responsible for all leadership responsibilities at a supervisor level including, but not limited to attendance and company approved time off for department team members, employee relations, training, corporate initiatives, and coaching.
Ensure leadership receives the appropriate updates and notification of potential business risks by providing and maintaining standardized reporting of metrics, statistics, accomplishments, priorities and issues.
Influence staffs to achieve organization & corporate objectives while helping employees understand current and new business directions.
Anticipate resource needs, establish appropriate priorities and eliminate unnecessary functions.
Establish and maintain functional and technical knowledge of Windward and enabling technologies to be able to respond to unique requests made by clients; work collaboratively with clients to meet their needs without compromising DQ principles.
Ensure regulatory and legal compliance within department.
Recognize and promote diversity in all aspects of resource management.
Other duties as assigned.
Bachelor Degree with 5+ years claim processing/healthcare experience
3+ years prior supervisory experience required
Technology acumen required
Excellent data analytics and problem solving skills
Ability to present and interact with clients regarding claim processing
Operate with little direction
Ability to manage others that do not have a direct reporting relationship
Strong computer skills including Word, Excel, and previous claim processing systems
Demonstrated ability to manage production/transactions
Strong business acumen
Ability to prioritize and organize multiple tasks and manage competing priorities.
Excellent math capabilities
Ability to make appropriate decisions within tight timeframes
Strong communication skills: written, verbal and interpersonal
Ability to work well with others at all levels of the organization.
Ability to manage multiple priorities and adapt to changing conditions