Supervisor – Health Plan Operations

Providence

Supervisor for Health Plan Operations at Pacific Medical Centers directing daily workflows of Claims Adjudicators. Responsible for ensuring compliance with health care regulations and managing claims processing.

Posted 7/16/2026full-timeRenton • Washington • 🇺🇸 United StatesMid-LevelSenior💰 $3,945 - $6,124 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing claims processing and compliance with government guidelines, while effectively leading a team in a healthcare environment. Proficient in budget management and operational workflow optimization within the claims adjudication process.

Highest-signal resume keywords

Claims ProcessingSupervisory ExperienceHealthcare AdministrationCompliance ManagementBudget Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationRevenue AccountingMedicare CodingTRICARE CodingCode Review Software Management

Soft Skills

Problem SolvingTeam LeadershipCommunication

Tools & Technologies

Centricity

Industry Keywords

DoD ComplianceOutside Purchased ServicesHealth Care ClaimsPacific Medical Centers

About the role

Key responsibilities & impact

Organizes and directs the daily activities and department workflow of the Claims Adjudicators and Claims Support Staff under the supervision of the Director of USFHP Operations.
Ensures accurate and timely accounting of Pacific Medical Centers' revenues and expenses for Outside Purchased Services (OPS).
Timely and accurate processing of claims and materials needed for the adjudication of claims.
Assures compliance with DoD and other government agency guidelines and contract requirements.
Sets Claims policy and monitors compliance to same.
Monitors Medicare and TRICARE coding and payment guidelines and educates staff in changes.
Identifies and solves payment issues with outside providers.
Serves as the principle contact with IT for Centricity night jobs, check runs and warehouse updates of claims materials.
Ensures that delegation standards are met, coordinates monthly reporting and yearly reviews by each plan to assure continued compliance with standards.
Manages revisions to the code review software module.
Responsible for storage and retrieval of claims and associated paperwork.
Serves as a member of the US Family Health Plan management team.
Jointly manages the US Family Health Plan budget with the Director of USFHP Operations and the other members of the management team.

Requirements

What you’ll need

4 years Health care claims experience.
2 years Supervisory capacity, including Lead role; or six months supervisory experience within Pacific Medical Centers.
Bachelor's Degree in Health Care Administration or Business Administration (preferred).

Benefits

Comp & perks

Health care benefits (medical, dental, vision)
Retirement 401(k) Savings Plan with employer matching
Paid parental leave
Paid vacations
Paid holidays
Paid time off for health issues
Voluntary benefits
Well-being resources