Community Health Plan of Washington

Supervisor, Claims BPO Operations

Community Health Plan of Washington

full-time

Posted on:

Location Type: Remote

Location: Washington • United States

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Salary

💰 $93,200 - $148,190 per year

About the role

  • Responsible for the direct supervision of Operations staff, including interviewing, hiring, performance management, time keeping records, training, coaching and employee development
  • Building a cohesive, empowered and productive work environment
  • Responsible for improving production processes and quality on a continuous basis
  • Manage prioritization of system configuration, testing and implementation activities involving claims and encounter data
  • Facilitate the development and execution of user acceptance scenarios and scripts for testing system changes and enhancements
  • Manage claims and billing Clearinghouse (TPA) for Medicaid programs
  • Oversee end‑to‑end claims and billing operations with the TPA for Medicaid programs, ensuring accuracy, efficiency, and alignment with program requirements
  • Provide strategic guidance to providers on claims preparation and submission, including developing training materials and enabling process improvements
  • Ensure timely and compliant submission of all required program documentation, maintaining strong operational controls
  • Lead oversight of clearinghouse claim workflows, including escalation management, technical issue resolution, and root‑cause analysis for provider rejections
  • Drive program compliance and performance through rigorous monitoring, reporting, and continuous improvement initiatives
  • Regularly monitor departmental contractual compliance with state, CMS, OIC requirements (claims benefit configuration, claims timeliness, claim denials, encounter data submissions, clearing house); including supporting the collection and submission of required operational performance metrics and data reporting requirements
  • Provide oversight including SLA reporting and audit to Operations’ assigned vendors
  • Lead the analysis and documentation of business process workflows, policies and procedures for Operations
  • Act as the subject matter expert for Operations in companywide or specific projects, including configuration on vendor systems
  • Monitor the performance of processes within the Operations Department identifying improvement strategies and interventions when targets are not met
  • Lead and guide process owners and internal stakeholders in the planning and execution of process improvement activities including identifying suitable strategies, methodologies and interventions necessary to achieve desired outcomes
  • Take a leadership role working with project teams to develop and track key performance targets and metrics to effectively monitor improvement activities and interventions
  • Regularly report results to management and project owners
  • Participate in and oversee the work involved in a variety of audits including TEAMonitor, HEDIS, NCQA, CMS, Internal audit.

Requirements

  • Bachelor’s degree in health care or an equivalent combination of education and highly equivalent experience required
  • Minimum five (5) years’ managed care/health plan operations experience required
  • Minimum four (4) years’ leadership (supervisory/management) experience in a related field, required
  • Minimum three (3) years’ experience as a Senior Operations Analyst at CHPW, preferred
  • Experience overseeing healthcare claims operations, including benefits administration, system configuration, and implementation of complex provider rates, pricing methodologies, fee schedules, clearing house administration
  • Proven leadership in managing professional and institutional claims within third‑party administration environments, ensuring accuracy, compliance, and operational excellence
  • Background in Medicaid, Medicare, OIC claims administration, benefit interpretation predilection for process improvement, identifying, planning and executing appropriate strategies, methodologies and activities to achieve team and company goals.
Benefits
  • Medical, Prescription, Dental, and Vision
  • Telehealth app
  • Flexible Spending Accounts, Health Savings Accounts
  • Basic Life AD&D, Short and Long-Term Disability
  • Voluntary Life, Critical Care, and Long-Term Care Insurance
  • 401(k) Retirement and generous employer match effective the 1st of the month following or coinciding with the employee’s start date
  • Wellness programs (Employee Assistance Program and Mental Fitness app)
  • Financial Coaching, Identity Theft Protection
  • Paid Time Off (PTO) including PTO accrual starting at 17 days per year
  • 40 hours Community Service volunteer time
  • 10 standard holidays, 2 floating holidays
  • Compassion time off, jury duty
  • A monthly stipend to offset work-from-home expenses for roles that are 100% remote
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
claims operationssystem configurationuser acceptance testingprocess improvementdata reportingaudit managementperformance managementbilling operationsroot-cause analysisMedicaid program compliance
Soft Skills
leadershipcoachingemployee developmentstrategic guidancecommunicationproblem-solvingteam collaborationorganizational skillsperformance monitoringinterpersonal skills