Claims Examiner Supervisor
S2 - Univita - Nashville, TN

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It's the new age of independence. And it's changing the way we live.
BE PART OF IT. UNIVITA is dedicated to helping people live and age with independence. By providing a single place to find and manage resources which support independent living, UNIVITA makes it easier to access care and to age safely at home.

This is your opportunity to join an innovative company with a culture that promotes compassion, trust and accountability.

ABOUT THIS OPPORTUNITY In this position, you will provide leadership and technical direction to the Claims Support and Examiner team, which is primarily outsourced to ensure that claims are handled promptly, accurately and efficiently. You will also manage vendor results and interact with subject matter experts and have responsibility for system enhancements, issues and testing.

RESPONSIBILITIES
  • Assign and supervise claims support and examiner staff with about 3 people and oversee the outsourcing of the majority of the claims exam work.
  • Organize the day to day workflow, monitor day to day production and reporting, and review quality of training for off shore staff and on-site employees.
  • Ensure work is completed in a timely manner to meet customer expectations, which includes assisting with the internal hiring process and any human resource issues.
  • Assists staff including the outsource vendor with questions and problems relating to claims administration and completing quality reviews.
  • Handle non-routine claims which include communication with existing clients on special claim exam issues. This may include training on new processes and clients with the outsource vendor.
  • Provide input towards system re-design for improved efficiency and quality.
  • Develop new and on-going procedures and policies for new and existing clients, including revising existing policies and procedures.
  • Communicate with director/manager about problems involving team operations such as workflow & claims services including client development activity.

ESSENTIAL FUNCTIONS
Title: Supervisor, Claims Exam
  • Supervises claims Support and Examiner staff. Organizes the day to day workflow, monitors day to day production and reporting, training and quality review. Responsible for making sure work is completed in a timely manner to meet customer expectations. This includes assisting with the internal hiring process and responsibility of any human resource issues.
  • Assists staff with questions and problems relating to claims administration and completing quality reviews. Personally handles non-routine claims which include communication with existing clients on special claim exam issues. This may include training on new processes and clients.
  • Provides support to intake team that may include monitoring of phone service.
  • Provides input towards system redesign for improved efficiency & quality. Responsible for accurate and timely testing.
  • Develop new and on-going procedures and policies for new and existing clients. This includes revising existing policies and procedures.
  • Communicates with Director/Manager about problems involving team operations such as workflow & claims services including client development activity.
  • Other duties as assigned.
QUALIFICATIONS
  • Bachelor's degree or equivalent business experience
  • Knowledge of claims processes of health, life, disability and/or long term care
  • Ability to lead staff or manage offshore vendor activities including ability to organize, prioritize, motivate and promote team work
  • Excellent written and verbal communication skills
  • Analysis and judgment in claims process
  • Extensive knowledge of claims system and procedures
  • Human relations skills
  • Ability to exercise a certain degree of judgment of questionable claims
  • Provide prompt, courteous and accurate service to internal and external customers at the lowest possible cost without sacrificing excellent service

S2 - Univita - 2 years ago - save job