KEY RESPONSIBILITIES
other duties as assigned
The Supplemental Health Claims Supervisor is responsible for ensuring that all Wellness, Accident, Critical Illness, and Hospital Indemnity claims assigned to his/her team are accurately and fairly adjudicated in a timely manner according to plan provisions, established best practices, and within company, state and federal guidelines. The Supervisor is responsible for ensuring operational excellence and collaborates with other members of the management team to improve operations beyond his or her team.
Managing the Claims Block
Manage the prompt and accurate investigation, adjudication, and payment (where appropriate) of claims within established guidelines.
Delegate, distribute, and monitor workflow within the department to meet turnaround times, improve efficiency, and realign caseloads to reduce or eliminate backlogs.
Ensure that workflows, procedures, and best practices are followed to improve the accuracy, efficiency, and effectiveness of claim management.
Utilize available reporting resources and file reviews to ensure that established department goals are being met.
Continually improve and develop examiners’ skills relative to case strategy, decision-making, investigation, evaluation, and communication through file review and coaching.
Ensure the Claims Management System is current and any changes are communicated.
Customer Service
Ensure the achievement of specific customer service quality and production objectives as established.
Promptly address clients’ needs and address complaints that may be escalated to you; track, identify, and address issues as appropriate.
Develop, model, and maintain effective working relationships with external (policyholders, brokers) and internal (sales, underwriting, administration) contacts.
Assist in the sales process including Requests for Proposal (RFP), sales presentations, and training of sales personnel.
Subject Matter Expertise
Provide technical, claim-specific guidance and direction of claims presenting complex or unusual issues.
Ensure compliance with established procedures and assist with audit activities.
Suggest changes to policy language as necessary and participate in the development of new products.
Perform focus reviews and review Quality audit results.
Review adverse determination letters for content and provide feedback as needed.
Regularly meet with staff to discuss new procedures, and trends identified in quality reviews, reinforce training efforts, communicate results, share information or problems, and provide a forum for team building.
Leadership
Miscellaneous
REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE
or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience
Required Knowledge, Skills, Abilities, and/or Related Experience
Ability to Travel: Up to 10%
PHYSICAL REQUIREMENTS
When used in the description below, the following terms are defined as:
“Occasional”: done only from time to time, but necessary when it is performed
“Frequent”: regularly performed; generally an act that is required on a daily basis
“Continuous”: typically performed for the majority of an employee’s shift
Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law.
CORE VALUES
The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job.
The expected hiring range for this position is $66,660.00 - $88,980.00 annually for work performed in the primary location (Phoenix, AZ). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future.
Work location may be flexible if approved by the Company.
What We Offer
At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you.
That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing.
Our Benefits:
Our Values:
EEO Statement
Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications.
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