Supervisor, Claims
Description Remote and must live in the United States JOB DESCRIPTION Job Summary - Leads and supervises team responsible for claims activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. - Also monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion and in accordance with cost-control standards. Essential Job Duties - Coordinates workflow and staffing of day-to-day claims activities and assigns and monitors work of staff in order to adhere to productivity and quality standards. - Hires, onboards, trains, supervises, and develops claims team, and demonstrates accountability for team performance. - Proactively plans for daily claims priorities, and responds to new priorities and process improvement opportunities assigned by leadership. - Ensures execution of claim handling strategies including appropriate determination of coverage, processing guidelines and metrics. - Reviews and analyzes claim reports to identify and address trends; recommends strategies to correct adverse trends. - Effectively manages claims escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure. - Reviews and documents recommendations for claim disposition including evaluation, negotiation and settlement of claims in excess of staff authority levels. - Compiles and submits daily, weekly and monthly departmental claims reports to leadership. - In collaboration with senior claims leadership, develops claims department initiatives to improve overall efficiency. - Completes claims projects as assigned. 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. Preferred Qualifications - Management/leadership experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V