Claims Supervisor

Job ID: J126391
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

JOB SUMMARY

This job supervises and coordinates the day to day activities of the various claims processing or claims adjustment units responding to internal inquiries or inquiries received by members, providers, or account representatives across all markets.

ESSENTIAL RESPONSIBILITIES

  • Communicate effectively.
  • Effectively supervise all assigned personnel.
  • Coordinate any claim backlog distribution for regular and overtime work both inter-departmentally and company wide. 
  • Monitor and manage daily inventories to ensure adequate staffing and resources are available.
  • Subject matter expert for benefit plan and claims processing issues, implementation of new groups and products, and transition meetings.
  • Research quality issues and respond to error assessments.
  • Ensure all business processes are routinely monitored. 
  • Recommend and design, if necessary, process improvements designed to improve accuracy, timeliness of process and/or eliminate manual effort.
  • Other duties as assigned or requested.

QUALIFICATIONS

Minimum

  • High School Diploma or GED
  • 2 years of experience in a claims environment
  • 1 year of experience leading or supervising others

Preferred

  • Bachelor’s degree

Skills 

  • Knowledge of multiple processing systems and workflows
  • Knowledge of claims processing methodologies
  • Ability to interpret all government regulations.
  • Knowledge of Highmark products.

SCOPE OF RESPONSIBILITY  

Does this role supervise/manage other employees?         

Yes 

WORK ENVIRONMENT

Is Travel Required?

Yes

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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