Job Description :
I. GENERAL OVERVIEW:
Supervises and coordinates the day to day activities of the various claims processing or claims adjustment units responding to internal inquiries or inquiries received by members, providers, or account representatives across all markets.
II. ESSENTIAL RESPONSIBILITIES:
1. Communicate effectively.
2. Effectively supervise all assigned personnel.
3. Coordinate any claim backlog distribution for regular and overtime work both interdepartmentally and companywide.
4. Monitor and manage daily inventories to ensure adequate staffing and resources are available.
5. Subject matter expert for benefit plan and claims processing issues, implementation of new groups and products, and transition meetings.
6. Research quality issues and respond to error assessments.
7. Ensure all business processes are routinely monitored. Recommend and design, if necessary, process improvements designed to improve accuracy, timeliness of process and/or eliminate manual effort.
8. Other duties as assigned or requested.
- High School Diploma or GED
- 2 years experience in a claims environment
- 1 year experience leading or supervising others
Knowledge, Skills and Abilities
Knowledge of multiple processing systems and workflows
Knowledge of claims processing methodologies
Ability to interpret all government regulations.
Knowledge of Highmark products.
IV. SCOPE OF RESPONSIBILITY:
Does this role supervise/manage other employees? Yes
If yes, indicate the number of direct reports:
V. WORK ENVIRONMENT:
Is Travel Required? Yes
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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