SPV CORP CLAIMS in Woburn, MA at Beacon Health Options

Date Posted: 1/28/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Supervisor of Claims to join our team at our office in Woburn.  The Supervisor of Claims is responsible for leading the daily activities of the Claims Specialists to ensure claims are processed in a timely manner, accurately, and meeting productivity quotas. They are also responsible for ensuring compliance within company (SOC) and industry standards. They will act as the department coordinator for routine business and special projects related to Claims Specialists functions.

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Position Responsibilities:

  • Provide daily leadership for associates to obtain optimal results

  • Manage prioritized and escalated claim issues

  • Facilitate required claim processing changes with regional operations teams

  • Balance workloads to ensure optimal assignment of projects/reprocessing requests

  • Track volume of Queue and Pending folders to determine productivity levels of the team and staffing requirements

  • Oversee check run cycles, both on and off, to ensure prompt pay guidelines are met

  • Develop, submit and approve adjudication logic rules for Woburn managed Plans

  • Overall management of the Claims Management module in FLEXCARE including: New, Queues and Pending folders.Works in conjunction with other Claims Supervisors

  • Primary Claims contact with outside vendors, such as Payspan, EDIFECS, FIS, and 3M.

  • Overall management of the Claims SharePoint site and any claims specific email boxes

  • Ensures availability as a resource to the team to assist with problem solving

  • Ensures annual P&P review and updating is completed

  • Maintains and updates SOPs accordingly

  • Maintain a thorough knowledge of the processing requirements for each Plan’s adjudication rules and industry standards

  • Ensures SOC Controls are completed and meet requirements

  • Be able to collect and analyze data to identify individual opportunities for improvement

  • Seek, gather and analyze relevant data to address claim processing issues effectively

  • Identifies opportunities for process and system improvements

  • Able to work collaboratively with all Beacon staff, clients, and external providers to ensure resolution to claims related issues.

  • Ability to manage and coordinate with internal departments

  • Conduct individual and group meetings with team

  • Establish training plan for new hires

  • Conduct annual employee evaluations

  • Track employee occurrences

  • Manage employee timecards and PTO requests using department guidelines

  • Other duties as assigned

Position Requirements:

Education: Bachelor’s Degree in Business, Healthcare Administration or related fields; or an equivalent combination of education, training and experience is required

Relevant Work Experience:  minimum of five years’ of related work experience

Knowledge, Skills & Abilities:

  • Ability to handle demanding caseload, make independent decisions and multi-task.

    TO APPLY

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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/D