Supervisor Claims & Customer Service

Job ID: J125757
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

GENERAL OVERVIEW: 

The Supervisor Claims and Customer Service supervises staff and coordinates the day to day activities in a multi-faceted claims and service unit providing end to end operations across all markets.    Respond to inquiries in an accurate and timely manner ensuring acceptable service levels, metrics, and/or performance guarantees are achieved.  Effectively supervise all assigned personnel including monitoring and assuring acceptable levels of performance, productivity and quality are met.

ESSENTIAL RESPONSIBILITIES:

1. Communicate effectively.  This position displays effective communication skills while performing the following functions: Ability to converse with all levels of personnel.

2. Effectively supervise all assigned personnel.

  • Monitor and assure acceptable levels of performance, productivity and quality are met for all personnel. 
  • Coach and mentor employees to maximize performance and behaviors.    Monitor the performance of employees and recommends corrective action for employees when performance and standards decline. 
  • Provide career development to maximize employee’s performance.  
  • Complete administrative tasks such as, performance reviews, time and attendance, training requests, system access, move requests, disciplinary actions
  • Provide assistance and guidance to staff on more complex issues.   Handle all issues escalated to this level in accurate, timely manner.
  • Review daily inventory and staffing levels and makes assignments accordingly.    Monitor and manage daily call volumes, aged cases, trends to ensure adequate staffing and resources are available to ensure performance goals are met and maintained
  • Schedule meetings with staff to communicate any information changes or updates

3. Respond to members, providers, group administrators, legislative and regulatory agency inquiries in an accurate and timely manner ensuring acceptable service levels, metrics, and/or performance guarantees are achieved.

4. Monitor  claims and calls for quality assurance either side by side, one on one or silent monitoring.

5. Plans, coordinates and participates in project activities.

6. Other duties as assigned or requested.

QUALIFICATIONS:

Minimum Education and Experience

  • High School/GED
  • Two (2) years experience in customer service or claims environment
  • One (1) year experience in leading or supervising others

Preferred Education and Experience

  • Bachelor’s Degree

Knowledge, Skills and Abilities

  • Knowledge of multiple processing systems and workflows.
  • Knowledge of  various telephone or call center systems
  • Knowledge of all Highmark products
  • Knowledge all Pennsylvania Insurance Department regulations, HIPAA, TEFRA, SOX and Act 83 and Highmark Operational and Corporate Policies.

SCOPE OF RESPONSIBILITY

Does this role supervise/manage other employees? Yes

WORK ENVIRONMENT

Is Travel Required? Yes

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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