Medical Claims Supervisor

    • Job Tracking ID: 512935-611908
    • Job Location: Meridian, ID
    • Job Level: Management
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: March 09, 2018
    • Years of Experience: 2 - 5 Years
    • Starting Date: April 23, 2018
    • Salary Type:: Salary
    • Rate:: $50,000+ (DOE)
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Job Description:

Job Summary


Claims processing is at the heart of AmeriBen’s service model. Recognizing there is a person and a circumstance behind every claim processed, the Claims Supervisor is responsible for guiding and managing a staff of claims processors and supporting roles to meet client, member, and provider expectations. The Supervisor is responsible for promoting ACT (Accuracy, Customer Service, and Timely Turnaround), while identifying enhancements and changes to processes and workflows to increase quality.


Key Result Areas


  • Possess a strong understanding of claims processing, self-funding and third party administration. The Supervisor will be an internal resource for others as it relates to claims questions and problem solving.

  • Organize and manage team meetings

  • Determine staffing requirements

  • Oversee the direct reporting staff including Department Leads, and Trainer(s)

  • Analyze and improve metrics, processes and systems as it relates to the overall claims process

  • Provide feedback to Claims Department team members on inventory, TAT and quality

  • Balance tasks within the Claims Department

  • Assist in interviewing for new staff

  • Prepare and give job evaluations and performance feedback

  • Analyze aging reports to ensure timely processing of claims

  • Analyze data to efficiently balance workloads, TAT (turnaround time) and quality

  • Analyze processes to identify, promote and facilitate process improvement

  • Assist in quality initiatives in the Claims Department

  • Handle escalated issues

  • Produce weekly narrative report for Supervisor

  • Represent the Claims Department with clients as needed

  • Performs other related duties as assigned or needed

  • Approve vacation and sick leave

  • Coordinate financial and budget activities for maximum operational efficiency.

  • Monitor and provide timely feedback to team members regarding performance

Experience and Skills:

Minimum Qualifications


  • High school degree or equivalent

  • 3-4 years medical claims processing experience and exceptional skills

  • Ability to learn new technology and information

  • Problem solve effectively

  • Ability to handle pressure situations, personnel, and management

  • Exceptional communication skills both written and verbal

  • Ability to delegate

  • Ability to maintain confidentiality

  • Understanding of the GBAS system and reports

  • Ability to work efficiently, be organized, perform multi-tasking, prioritize tasks, and meet tight deadlines

  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self

  • Ability to maintain excellent working relationships with all departments

  • Industry knowledge of TPA products

  • Department must maintain good customer service relationships with clients, providers, and patients

  • Department must meet the following general standards:

    • 90% of claims processed in 10 business days or less

    • 99% Financial Accuracy

    • 99% Payment Accuracy

    • 97% Procedural Accuracy

  • Finalize special projects as requested

  • Completes all projects in a timely and accurate manner

  • Protect and enhance the Core Purpose and the Core Values of AmeriBen.