Supervisor, Claims (Must reside in FL)
On-site · Florida, United States
Job Summary
Leads and supervises a claims team responsible for processing medical claims, including administering payments, maintaining records, and advising Providers on coverage and benefit interpretation. Oversees backlog and workflow to ensure timely settlements in alignment with cost-control standards, training and developing staff, planning daily priorities, and implementing process improvements. Responsible for ensuring adherence to claim handling strategies, evaluating coverage and processing guidelines, analyzing claim reports to identify trends, managing escalations, and producing departmental claims reports for leadership. Collaboration with senior leadership to drive departmental efficiency and complete assigned claims projects.
Required Qualifications
- At least 5 years of medical claims processing experience, or equivalent combination of relevant education and experience.
- Thorough knowledge of processing outpatient and inpatient facility claims for Medicare, Medicaid, and Marketplace plans.
- Research, analysis, data entry, and auditing skills.
- Organizational skills and attention to detail.
- Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
- Ability to work cross-collaboratively in a highly matrixed environment.
- Strong customer service experience.
- Effective verbal and written communication skills.
- Microsoft Office suite and applicable software programs proficiency.
Additional Requirements
- Must reside in Florida (FL)
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