Lead the activities necessary to process advanced claim queues for Group and Individual (Commercial Programs) while achieving superior operational performance and process excellence. Accountable for management of all claims payment for dedicated units.
- Ensure all G&I advanced and designated claims are processed within client contractual requirements.
- Provide team of subject matter experts in benefits and claim processing for all clients and products within the G&I portfolio.
- Serve as G&I expert as to how claims are processed, payment compliance, turn around times, interest requirements, and all other payment related processes.
- Lead the timely, accurate, and efficient processing of advanced G&I claims.
- Provide back up for payment responsibilities.
- Manage daily forecast to ensure proper utilization of labor and overtime to achieve the maximum service levels within budget.
- Assist in the development of staff measurements and ensure all department production standards are met.
- Provide consistent and effective leadership to team members establishing 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 daily ad hoc advanced claim challenges from all constituents
- Initiate and recommend necessary policies and procedures to Manager 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 cross functional DQ staff to meet client 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
- Excellent math capabilities
- Strong Technology acumen required
- Excellent data analytics and problem solving skills
- Excellent communication skills: written, verbal and interpersonal
- Ability to present and interact with clients regarding claim processing & payment
- 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.
- Ability to make appropriate decisions within tight timeframes
- Ability to work well with others at all levels of the organization.
- Ability to manage multiple priorities and adapt to changing conditions