Supervisor, Claims WageWorks
THIS JOB HAS EXPIRED With general direction and latitude for independent judgment and discretion, this position supervises the daily workflow and production of a claims and adjustment processing team with a major focus on claims escalations.
1. Carries out the personnel actions for a claims and adjustment processing team, which includes but is not limited to hiring and scheduling employees; training and evaluating employees; coaching, counseling and managing performance; and making salary, merit or other pay increase recommendations. This position may also make recommendations or execute corrective actions as necessary.
2. On a daily basis, monitors and supervises the activities of claims processors and adjustors to ensure the timely receipt, adjudication and completion of Flexible Spending Account/commuter claims, remittances, FSA/HSA adjustments, and commuter adjustments. Ensures that claims are processed within approved time limits.
3. On a daily basis, monitors and supervises reimbursement check remittance processes and workflow, including check voids and 90 days check void processes to ensure that checks are disbursed in an accurate and timely manner, meeting the performance standards set forth. Reconciles remittance checks accordingly.
4. Based on direction and targets from the Claims leadership team, creates and maintains department and staff goals and monitors progress towards achievement of those goals. Takes action to redirect activities when appropriate.
5. Documents and maintains procedural documentation for use including but not limited to staff training. Works closely with the claims leadership team to streamline operational processes where possible.
6. Tracks the teams performance to expectations. Provides reports of the teams performance to the claims management team, providing feedback and suggestions for change to increase operational effectiveness.
7. Acts as a third primary tier of support for escalated issues and works to resolve denied or pending claims as expeditiously as possible. This includes identifying, researching and correcting claims issues within an on-line system. Issues typically require the ability to use independent judgment and discretion to adjudicate claims. Resolution also may entail direct interaction with other internal departments, customers, employers, healthcare facilities, etc. to gather additional information for analysis.
8. Works cross-functionally with other departments to address customer or business issues and resolve errors and/or issues in a timely manner. Serves as an example to the claims team for collaboration and consistent customer focus.
9. Maintains current and complete awareness of products and services to effectively provide direction and respond to issues that claims processors may encounter. This may involve attending advanced training sessions or meetings in which information is imparted and discussed.
- Bachelors Degree in business management or a related field preferred or comparable experience.
- The ability to provide effective support of escalated claims issues and supervise check remittance processes, as described, as normally obtained through at least three to four years claims experience.
- Demonstrated understanding of claims operations including the ability to manage staff performance as normally obtained through at least two years of supervisory experience in a claims environment.
- Experience working with flexible spending accounts and cafeteria plans is preferred, although not required.
- Ability to understand pre-tax benefits, flexible spending account (FSA) benefits and health spending accounting benefits to be able to base determinations of claim eligibility is required. Additionally, a solid knowledge and understanding of bank reconciliation, debit or credit card operations is required.
- Good analytical skills and problem solving skills are necessary. The ability to uncover facts and use that information to effectively solve issues is also required. An attention to detail is essential.
- Abilities to multi-task and to work under specific time constraints is required. Organizational skills and time management skills are essential.
- Strong oral, written and interpersonal skills are required as is the ability to remain customer service focused during situations in which customers may be notably frustrated.
- Demonstrated strong interpersonal skills in a team-based environment are also necessary to supervise the team as described. Previous coaching experience is required.
- The ability to balance costs with performance management is essential. The ability to manage performance through metrics is also required.
- The ability to maintain the confidence of sensitive information is essential.
- Advanced PC knowledge and understanding of Microsoft Office Suite, specifically with Word, and Excel. A solid understanding/proficiency with web-based tools is also required. Data management experience is also required.
||Tempe, AZ |
THIS JOB HAS EXPIRED