Claims Supervisor
Claims Supervisor
Posted on :
21-04-2025
Employer Active
1 Vacancy
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Job Description
Curative is searching for an experienced Claims Supervisor. This position successfully manages the daytoday activities of the Claim Team. Performs all duties below while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.
ESSENTIAL DUTIES AND FUNCTIONS:
- Successfully manages the daytoday operations of the Curative Claims Team
- Serves as a key point of contact for audits claims payments questions and customer service.
- Ensure consistent training auditing and feedback is given to all staff.
- Consistently ensure the Claims Team meets/exceeds the following standards:
- Claims processing turn around.
- Procedural and financial accuracy
- Payment Cycle Review
- Manage the repricing process for nonpar and OON claims in accordance with turnaround time standards and client specifications.
- Work closely with IT Medical Services System Support to ensure efficiency.
- Work with Accounting Executive and HR departments to define needed processes.
- Reviews High Dollar Claims for completeness and approves or denies payment using established guidelines and making all required internal notifications.
- Clearly and concisely documents claim adjudication decisions in Claim Notes.
- Works with the System Configuration department to ensure proper benefit setup.
- Completes required sample of professional and facility claims to audit for accuracy as required by the client.
- Completes focused audits for error trends identified during processing or pre
release audit. - Identify claim analyst training opportunities and provider billing issues.
- Submits audit results to the Claims Manager for review and final submission to clients.
- Acts as claims team resource for claims questions and benefit interpretation.
- Provides claim staff training via email alerts and training sessions.
- Reviews results of all prospective/retrospective audits provided from various sources to ensure that claims processing is handled as mandated by client directives.
- Analyzes tracks and trends provider system setup and claim errors.
- Works on claims team projects and reporting assigned.
- Assists with all groups for professional and facility claim processing.
- Attend departmental training when required or requested.
- Adheres to the rules and regulations of Curative as described in the Employee Handbook and as defined in the unit/department/clinic procedures.
- Performs other duties and projects assigned.
MINIMUM QUALIFICATIONS:
Education:
- High school diploma or equivalent. Bachelors /Associate degree preferred.
Experience:
- At least 35 years of Claims Supervisor and/or Management experience required including HMO PPO ERISA and government plans experience.
- Experience working with Health Edge Health Rules Payer system a variety of claims payment systems processing of all claim types to include hospital/facility behavioral health dental vision and professional medical claims. Experience working with the VBA claims system. Customer Service experience preferred.
Knowledge Skills and Abilities:
- Ability to communicate with all levels of staff.
- Advanced Knowledge of claim coding and editing rules
- Knowledge of TDI regulations and requirements for claims payments
- Knowledge of HIPPA regulations
- Knowledge of medical terminology IDC10 CPT and HCPCS coding.
- Proficient computer skills to include Microsoft Office applications.
- Excellent verbal and written communication skills
- Ability to communicate clearly and effectively.
- Ability to sit for extended periods of time at a computer workstation.
PHYSICAL DEMANDS:
SEDENTARY (requires lifting to 10 lbs. carrying small objects)
Required Experience:
Senior IC
Employment Type
Full-Time
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