Health Plan Claims Supervisor

A company is looking for a Supervisor, Health Plan Claims Operations.

Key Responsibilities

Oversee claims quality and timeliness of payment, ensuring compliance with regulations

Manage TPA operations and monitor service delivery against SLAs

Identify and implement process improvements to enhance operational efficiency and member satisfaction

Required Qualifications

Bachelor's degree or 6+ years of relevant healthcare operation experience

Four years of experience managing healthcare operation teams, including claims and billing

Strong knowledge of ACA / IFP and commercial claim requirements

Experience in oversight management of TPA operations

Background in developing and reviewing operational SOPs and business requirement documents