| Title: Claims Supervisor
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| Location: Downey, CA
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| Job Type: Contract
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| Compensation: per Hour
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| Reference Code: 951391-WQG
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Description: This person supervises assigned team members, manage inventory and work distribution in a Claims Processing Unit. This person assists in hiring, training, and evaluating team members in assigned section. This role provides coaching and mentoring to team members to enhance performance and development and promote team building; and identifies additional training needs and monitors performance against established indicators.
The responsibilities of this position include the following:
- Coordinates and communicates regularly with other supervisors to share information, best practices, system issues, questions, training needs, and team performance status relative to process and quality standards
- Provides recommendations and assists management with budget development process
- Responsible for monitoring cost containment and quality standards
- Participates in management team committees and task forces related to operations as assigned
- Ensures compliance and government regulations including but not limited to those of HCFA, DOC, DHS and requirements of accrediting agencies such as NCQA
- As necessary, assumes responsibilities of department during absence of manager
- Assists in reviewing internal controls to ensure proper adjudication and payment of claims
- Develops schedules to ensure proper staffing and production levels are maintained
- Collaborates with Utilization Review, Medical Centers, and other Administrative staff in resolving benefit interpretation and validity of claim charges
- May assist in claims analysis during high volume periods
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Requirements: The skills, experience, and education required for this position include the following:
- A minimum of 7 years of progressively responsible medical claims experience or comparable experience is required
- 3 years of supervisory / management experience or demonstrated leadership ability is required
- Knowledge of various contracts is required
- Understanding of medical or clinical procedures is required
- Comprehensive knowledge of CPT, ICD-9, medical terminology, COB/TPL/WC is required
- Good oral, written, and interpersonal skills are required
- Previous experience working as a member in a team environment is preferred
- Knowledge of personal computer operations is preferred
- Medical contracting and regulatory agency interface experience is preferred
- Knowledge of AB1455 Provider Dispute process and compliance rules related to claims processing
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