Claims Supervisor

Job Description

Job Description

UNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare.

Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

The Claims Supervisor will supervise a team of direct reports and departmental inventory. This involves overseeing the scanning, uploading, and keying of UNITE HERE HEALTH member’s and dependent’s medical, vision, dental and short-term disability claims related correspondence.

This position is responsible for the accuracy and timeliness of handling of claims and member correspondence based on the guidelines set forth by the Department of Labor and is responsible for partnering with internal and external parties to ensure that the turnaround times are met.

The supervisor is relied upon as a subject matter expert for creating and updating provider records, Coordination of Benefits provisions, and eligibility related inquiries within the Department;

this includes providing support to the Legal Team as it relates to subrogation files. The position supports the production team functions in collaboration and coordination with the New Membership, Member Services and C&E teams.

This supervisor will provide development, training, and coaching to employees for guidance and direction to ensure that a high level of accountability and performance is delivered to our participants.

ESSENTIAL JOB FUNCTIONS AND DUTIES

• Provides leadership, motivates, advocates, coaches and develops team performance and promotes Fund culture / mission along with advocating for appropriate change with a positive attitude.
• Promotes operational efficiency and quality by critically analyzing team processes with the intention of improving member experience and creating a high level of consistency in the team’s quality and production results.
• Manages and reports on team inventory to ensure that departmental metrics are met.
• Successfully investigates and responds to escalated inquiries from internal and external sources.
• Allocates and cross trains team resources to complete goals, as well as assists in training to other UHH operational areas.
• Collaborates and partners with other Claims Department Supervisors to ensure consistency in processing across all teams and to identify ways to be more efficient, adaptable and participant focused.
• Ensures adherence to policies and procedures are consistently applied.
• Assists in the design and preparation of management reports.
• Collaborates with the Legal team to understand legal regulations and plan provisions.
• Demonstrates necessary competence in technical, industry standard and soft skills to effectively support and develop staff.
• Communicates with Executive Leadership through creation of the monthly Claims Department Dashboard.
• Interacts with members and UHH operational areas to resolve complex issues and to educate regarding policies and procedures when the opportunity arises.
• Ensures members Coordination of Benefits information is accurately and consistently updated and maintained.
• Oversees the creation and maintenance of provider records for accuracy and claim payments, as well as, annual 1099 reporting to IRS.
• Demonstrates personal accountability for personal actions as well as team and departmental results through ensuring claims and correspondence are handled in accordance to the guidelines set forth by the DOL and our internal Claims Policy Committee.

ESSENTIAL QUALIFICATIONS

• 4 6 years of direct experience minimum
• Bachelor’s degree in related field or equivalent work experience
• 3 5 years of supervisory experience including :
• Setting and monitoring team goals and measuring performance
• The ability to manage a team of office or remote based employees
• Coaching / mentoring / providing ongoing training for Claims Department employees
• Identify, motivate and develop emerging talent
• Conducting performance appraisals and administering performance improvement plans
• Professional level training that provides working knowledge of :
• Administration of welfare plan benefits
• High degree of Claims Processing Knowledge
• Understanding of Medicare, Medicaid, ACA, DOL regulations, ERISA and HIPAA
• Audit and billing procedures
• Plan documents and summary plan descriptions
• Vendor relations
• Eligibility rules

Salary range for this position : Salary $64,900 - $81,100. Actual base salary may vary based upon, but not limited to : relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs) : Monday Friday, 7.5 hours per day (37.5 hours per week) with potential for hybrid work-from-home arrangement.

We reward great work with great benefits, including but not limited to : Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

LI-Hybrid