Job Attributes

Work Schedule/Shift

Day

Job ID

5000441165806

Req. No

70033679

Job Title

Claims Resolution Unit Supervisor

Region

CHRISTUS System Office

Category

Healthcare

Division

Not Defined

Company

CHRISTUS Health

Travel

None

Facility

Corp USFHP-55100

Address

919 Hidden Ridge
Irving, TX  75038
US

Type

Full Time

Apply Now Claims Resolution Unit Supervisor Job in Irving

The Claims Resolution Supervisor is responsible for providing structure and supervision for the departments' daily operations and functions. The supervisor works to meet or exceed department productivity and quality standards by coordinating staffing, balancing workloads, developing and implementing policy, procedure, and efficient workflows. The primary function of this role is to supervise staff in root cause resolution of escalated provider claim issues and impact analysis of the issue. The leader of this team is responsible for owning the claims resolution process including the intake and documentation of inquiries, projects, and closing the loop with relevant internal and external customers. The supervisor insures that the analyst collaborates closely with peers and management to ensure that root cause issues are analyzed, tracked, trended, and reported to all impacted areas for quick resolution. Proficient in facilitation and interpersonal communication, the supervisor also consistently demonstrates skills in organization, prioritization, professionalism, and coaching others.

MAJOR RESPONSIBILITIES
  • Oversee the claims resolution process
  • Coordinate and communicate continuously with other departments to share information, best practices, systems issues, process solutions, and training needs
  • Proactively review and provide data analysis (root cause and trending issues) and financial impact assessment related to claims issues.
  • Ensure compliance with company and departmental policies and procedures
  • Establish and review internal controls to ensure goals, objectives, standards, and benchmarks for the department are met or exceeded
  • Strategizes resolution on highly sensitive matters in partnership with appropriate business partners to help mitigate reputational risk;
  • Works with business partners to handle difficult customer issues and to resolve complex situations urgently and with a high degree of professionalism.
  • Maintain working knowledge of workflow, systems, and tools used in the department
  • Maintains working knowledge of claims and configuration policies and procedures and trains associates on the same.
  • Works directly with claims, configuration, provider relations, and customer service to review and resolve complex issues related to provider/member claims.
  • Leads team to leverage insights to identify root causes of and trends in internal and external claims issues and shares those with functional business partners so they can take action to prevent future complaints, where possible.
  • Provides weekly, monthly, yearly, and ad hoc reporting to leaders and business partners.
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
  • Ability to deal with problems involving several concrete variables in standardized situations and manage sensitive issues with tact, diplomacy and good judgment on the telephone, in correspondence and in person.
  • Triages work to Configuration Support Analyst
  • Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
  • Screen, interview, and hire new employees
  • Training and development of new associates
  • Monitoring associate schedules - Review, correct, and approve employees' hours in a timely manner (Kronos time tracking)
  • Mentoring associates for career development: regular 1/1 rounding sessions, goal setting and routine assessments
  • Evaluate associate performance and recommend appropriate merit increases and promotions
  • Counsel associates regarding disciplinary and performance issues
  • Lead in the creation and maintenance of a positive working environment
  • Review employee engagement results and facilitate the development of action plans
  • Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
  • All other duties assigned by management

A. Education/Skills:

  • Excellent analytical skills
  • Self-starter
  • Exercises proper judgment and decision making to analyze the root cause of claims issues and resolve problems timely and accurately.
  • Ability to organize and prioritize work to meet deadlines
  • Strong computer application skills including, but not limited to, Microsoft Word, Excel, PowerPoint, and Visio
  • Excellent critical thinking skills
  • Ability to communicate effectively both verbally and in writing
  • Ability to exercise a high degree of independent judgment and discretion with respect to matters of significant importance.
  • Ability to handle and resolve complex issues independently
  • Knowledge of Medicare Advantage, Tricare and Health Care Exchange programs preferred
  • Knowledge of claims processing, system configuration, claim edits, provider data load, and adjustment adjudication preferred.
  • Knowledge of CPT/HCPCS, ICD10 coding and medical terminology.
  • Ability to learn new policies and processes based on written material and observation
  • Ability to establish and maintain professional, positive and effective work relationships 

B. Experience

  • Bachelor's degree in related field or 5-7 years Managed Health Care experience required
  • Prior management experience required, 2-5 years highly desired.
  • Managed Care Claims processing experience preferred
  • Provider Data Management experience preferred
  • Claim system configuration experience a plus
  • Prior experience working with TRICARE, Health Care Exchange, and Medicare Advantage highly desirable.
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