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Professional - Non-Clinical
Supervisor Claims Department
Houston, TX, US
We’re looking for a Supervisor of the Claims Department, someone who’s ready to grow with our company. 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. To 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 promotes 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 what it takes?
Job Duties & Responsibilities
• Provides direct supervision of the daily operations for Claims Examiners and Claims Benefits Specialists.
• Proactively identifies and solves problems with timely resolution of complex issues referred by Claims Examiners and Claims Benefits Specialists. Identifies the most appropriate course of action for problem resolution and effectively communicates the plans to those impacted. These issues frequently require research, collaboration with other departments, communications with external resources, and response creation.
• Provides daily management support to Claims Examiners and Claims Benefits Specialists.
• Participates in new-hire interviews and makes recommendations for candidate selection.
• Regularly monitors Claims Examiners and Claims Benefits Specialists using the weekly productivity log to ensure Claims Examiners and Claims Benefits Specialists are performing within Claims Administration’s production goals and identify any individual coaching or group training for long-term performance improvement and teamwork. Identify opportunities and recognize positive behaviors of Claims Examiners and Claims Benefits Specialists.
• Monitors available resources, system reports to facilitate the day-to-day operations to ensure that Claims Examiners and Claims Benefits Specialists are productive and have the necessary tools and information to perform their job. Responds to internal system trouble notifications and coordinates the involvement of other departments to facilitate problem resolution.
• Maintains visibility to Claims Examiners and Claims Benefits Specialists. Walks around periodically to perform live monitoring of Claims Examiners and Claims Benefits Specialists and provides support to those needing assistance.
• Responsibility B: Provides daily monitoring for Claims Examiners and Claims Benefits Specialists production stats.
• Provides front line for answers to questions and research.
• Performs post training follow up and review.
• Participates in quality initiatives and performance management.
• Initiates and completes check run process.
Skills & Requirements
• Required H.S. Diploma or GED
• 5 years of claims processing experience
About Texas Children’s
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.
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.
