Supervisor, Health Plan Claims Operations

Supervisor, Health Plan Operations

At Harbor Health, we are enhancing healthcare in Austin through strategic collaboration and innovative practices. We are looking for individuals to help us develop a member-focused experience that integrates comprehensive care with a modern payment model. If you are ready to contribute to a dynamic environment where your expertise is valued, we invite you to consider becoming a part of our team.

The Supervisor, Health Plan Operations, plays a critical role at Harbor Health by ensuring accuracy, integrity, and compliance with TDI rules and regulations. This position is responsible for claims quality and timeliness of payment while improving claims processing efficiency and accuracy, reducing operational costs, and improving member satisfaction. They oversee TPA business partner operations, ensuring TPA attains SLAs, manage the operation budgets, ensure quality for responsible teams, and monitor compliance with regulatory bodies. The position supports Harbor Health's mission by directly impacting the support of member satisfaction and health through timely and accurately processing healthcare transactions such as claims and supporting transactions.

Position Duties & Responsibilities

• Support service and product expansions : Assist in the operational aspects of service area and product expansions. Work closely with strategic planning and development teams to integrate new providers and services into the network.
• Inspect and review the quality of claims processing with providing feedback to TPA as appropriate.
• Review and approval of Cost Share claims between Harbor and TPA.
• Produce a monthly report on accuracy of Harbor's Cost Share selection logic.
• Proactively find opportunities to improve operational efficiency, member experiences and processes providing feedback to internal partners.
• Oversee TPA and their product partners to ensure the quality delivery of services.
• Building conditions for success removes obstacles, leads, and champions change.
• Responsible for ongoing monitoring of work to ensure consistent execution of processes and adherence to guidelines and frameworks.
• Manage issues and make appropriate decisions based on the policy.
• Facilitate and guide employees through skill identification and developing for career progression Supports projects by serving as a subject matter expert.
• Consistently coach employees on claims handling and find opportunities to improve overall process and engagement.
• Ensure risks associated with business activities are effectively identified, measured, supervised, and controlled in accordance with risk and compliance policies and procedures.
• Achieve monthly SLAs and address any misses with the TPA to resolve issues. This includes the TPA partner and their associated companies.
• Approve claim payment runs for release to production.

Required Professional Skills & Experience

Preferred Professional Skills & Experience

What We Offer

Harbor Health is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We are committed to creating an inclusive environment for all clinicians and teammates and actively encourage applications from people of all backgrounds.