Supervisor, Health Plan Claims Operations
Harbor Health
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Assist in the operational aspects of service area and product expansions.
- Work closely with strategic planning and development teams to integrate new providers and services into the network.
- Inspect and review the quality of claims processing with providing feedback to TPA as appropriate.
- Review and approval of Cost Share claims between Harbor and TPA.
- Produce a monthly report on accuracy of Harbor’s Cost Share selection logic.
- Proactively find opportunities to improve operational efficiency, member experiences and processes providing feedback to internal partners.
- Oversee TPA and their product partners to ensure the quality delivery of services.
- Building conditions for success removes obstacles, leads, and champions change.
- Responsible for ongoing monitoring of work to ensure consistent execution of processes and adherence to guidelines and frameworks.
- Manage issues and make appropriate decisions based on the policy.
- Facilitate and guide employees through skill identification and developing for career progression.
- Consistently coach employees on claims handling and find opportunities to improve overall process and engagement.
- Ensure risks associated with business activities are effectively identified, measured, supervised, and controlled in accordance with risk and compliance policies and procedures.
- Achieve monthly SLAs and address any misses with the TPA to resolve issues.
- Approve claim payment runs for release to production.
Requirements
- Bachelor’s degree or 6+ years of relative health care operation experience in ACA.
- Four years’ experience managing health care Operation teams that include claims, members, member/group billing, and provider domains.
- Strong knowledge of ACA/IFP and commercial claim requirements, rules, and regulations.
- problem-solving and managing multiple priorities.
- Previous team building and development experience.
- Detail-oriented, initiative-taking, and capable of working independently as well as part of a team.
- Prior work in implementing new insurance products by working with the TPA in bringing to production.
- Experience in oversight management of the TPA operations of claims.
- Background in developing and reviewing operation SOPs and business requirement documents.
- Strong written and verbal communication skills with the ability to know when each is appropriate.
- Prior experience in developing RFIs.
Benefits
- Opportunity to shape, develop and mentor individuals to grow their career and impact their lives.
- Collaborative and dynamic work environment
- An organization made up of people who are passionate about changing the healthcare landscape.
- Competitive salary and benefits package
- Professional development and growth opportunities
- A transparent and unique culture
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingCost Share claimsoperational efficiencyrisk managementSOP developmentbusiness requirement documentsRFI developmenthealth care operationsACA regulationsinsurance product implementation
Soft skills
problem-solvingteam buildingdetail-orientedinitiative-takingindependent workcommunication skillscoachingdecision-makingprocess improvementemployee development