Medical Claims Supervisor

 
Position: Medical Claims Supervisor

Job ID: 163208

Location: US-Remote TX Based, US-TX-Houston

Department: Claims - Administration

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for the women and children that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization. Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Supervisor of the Claims Dept -- someone who works well in a fast-paced setting. In this position, you will serve as a front-line supervisor by managing and directing the activities of a team of Claims Examiners and Claims Benefits Specialists. Handle claims processing concerns and issues requiring a high degree of appropriate knowledge, creativity, research, and communication with internal and external resources to achieve timely resolution. To ensure resources are utilized efficiently, in accordance with Claims Administration objectives that consistently promote internal and external customer quality and satisfaction. Assists the Manager of the Claims Department by monitoring the daily workflow for team members in reference to claim volume, receipts, and processing. To act as a communication conduit between the Claims Examiners, Claims Benefits Specialists, and management.

 

Think you’ve got what it takes



Responsibilities :

  • Provides direct supervision of the daily operations for Claims Examiners and Claims Benefits Specialists
  • Provides daily monitoring for Claims Examiners and Claims Benefits Specialists’ production stats
  • Provides front-line questioning/answer and research
  • Performs post-training follow-up and review
  • Participates in quality initiatives and Performance Management
  • Initiates and completes check run process
  • Manage Workforce


Qualifications:

  • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption
  • Diploma or GED
  • 5 years of claims processing experience


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