Claims Supervisor

Claims Supervisor

Remote within WA, OR, UT, ID

Onsite / Hybrid can be an option if an office is available in the local area.

Primary Job Purpose :

This role supports members, providers and various internal departments by mentoring staff, monitoring workflow, maintaining performance measures and ensuring timely and quality claims processing while adhering to State, Federal and company guidelines.

Responsibilities :

Assigns and prioritizes work, sets goals and coordinates daily activities of the team. Provides regular updates and communication to staff through 1 : 1 and team meetings.

Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and is in compliance with medical policy and guidelines.

Assists in development of productivity and quality standards. May conduct or participate in compliance audits and report audit findings.

Identifies and implements process improvements as needed. Ensures full participation of their team in MTM, URAC and all other compliance requirements.

Acts as a resource for staff and others. Appropriately escalates issues and partners with other departments to resolve issues and remove barriers.

Participates in the selection process, provides on-going coaching and performance management and is responsible for writing performance reviews.

Ensures new hires complete necessary training. Assesses training needs and plays an active role in development of staff.

Facilitates maintenance on reference manuals, work procedures and procedural guidelines.

Completes special projects as assigned, to include, leading division projects and / or implementing process improvement projects.

May lead projects where tracking and analyzing data and presenting to departmental leadership is required.

Participates on project teams by recommending solutions and translating business requirements, schedules and communications.

Oversees scheduling, reporting to management, meeting facilitation, issue resolution, and other support services as well as execution of the plans.

Ensures claims processing is managed accurately and timely according to company timelines.

Minimum Requirements :

Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.

Ability to effectively develop, train and lead a team (including employees who may be in multiple locations or work remotely) and assist in the development of productivity, quality and service standards.

Demonstrated analytical skills, ability to identify problems, trends; develop solutions and implement a course of action.

Ability to communicate effectively, verbally and in writing with all levels of the organization; to include strong customer service skills and the ability to work with internal and external groups or parties.

Knowledge of insurance industry and related regulations and mandates.

Ability to organize, plan and prioritize assignments within multiple projects.

Ability to participate in and at times manage well-defined projects with minimal guidance.

Experience working in a high volume claims processing center, with proven ability to effectively manage performance while creating an environment for service excellence.

Working knowledge of medical terminology and / or claims coding.

Supervisor of Member Services Claims would have a Bachelor’s degree and 3 years of experience related to claims processing, preferably in the healthcare industry and demonstrated leadership / supervisory experience, or the equivalent combination of education and experience.

FTEs Supervised

5-20

Work Environment

Duties performed in an office environment.

Travel may be required, either locally or out of state.

LI-remote

The starting salary for the Claims Supervisor is $61,200 - $82,200 a year depending on experience and geographical location.

The current full salary range for this role is $57,000 - 94,000. The bonus target for this position is 10%.

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training;

relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we do not hire candidates at or near the top of the pay range.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history.

Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.

Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can :

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include :

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our .

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law.

A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email .

Information about how Cambia Health Solutions collects, uses, and discloses information is available in our .