Claims Customer Service Supervisor

Supervisor Medi-Cal Claims

Supervise the Medi-Cal Claims Customer Service Specialists and Customer Service Representatives. Ensures delivery of highest level of customer service to the community and its medical providers.

Responsibilities

• Supervise the Medi-Cal Claims Customer Services Representatives I, II or III, Claims & Appeals Specialists, and Claims Resolution Coordinators.
• Supervise the customer service work-flow. Supports Claims Customer Service Specialist and customer service functions. Maintains CIF and adjustment inventories within established department guidelines. Maintains telephone response rates within established department guidelines.
• Review quality control audits with Customer Service staff to ensure compliance within established department guidelines, policies, and procedures. Identify errors and deficiencies; develop and implement corrective action and training plans for staff.
• Interview and participate in the selection of qualified candidates for the Claims Specialist and Claims Customer Service positions. Evaluate performance and provide developmental opportunities to staff. Provide training of new staff as appropriate. Counsel performance problems or issues when needed. Review and sign time cards.
• Review department policies and procedures, recommend changes for more efficient operations, communicate changes, and updates to staff when appropriate.
• Monitor and prepare production statistics and related reports for the Manager's / Director's review.
• Lead or participate in special projects and assignments as needed.
• Participate in provider meetings, both on and off site as required.
• Review and sign claim adjustment and high dollar claims within established guidelines.
• Other duties as assigned.

Qualifications

Education and Experience

Bachelor's degree in Health Care Services preferred; minimum three (3) years supervisor experience in a claims or customer service environment preferred; or equivalent combination of education and experience. Prior Medi-Cal or Medicare claims experience preferred.

Special Skills, Licenses and Certifications

Thorough knowledge of CPT, HCPC procedure coding, ICD-9 diagnostic coding, and medical terminology. Expertise in automated claims procedures and related problem resolution. Typing speed 30 wpm and proficient use of 10-key calculator preferred. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Excellent interpersonal skills with ability to lead and supervise staff to effectively complete assignments within established time frames and standards. Ability to effectively exercise good judgment and handle sensitive issues with frequent interruptions. Good organization skills.

Work Environment And Physical Demands

Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. More than 70% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 10 lbs.

All HealthPlan employees are expected to :

HIRING RANGE : $45.04 - $56.30

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.