Claims Customer Service Supervisor at Partnership HealthPlan of California

Fairfield, California, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Feb, 26

Salary

56.3

Posted On

22 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Service, Claims Processing, Supervision, Quality Control, Training, Performance Evaluation, Medical Terminology, CPT Coding, ICD-9 Coding, HCPC Coding, Problem Resolution, Organization Skills, Communication Skills, Interpersonal Skills, Time Management, Data Reporting

Industry

Insurance

Description

Overview To supervise the Medi-Cal Claims Customer Service Specialists and Customer Service Representatives. Ensures delivery of highest level of customer service to the community and its medical providers. Responsibilities Supervises the Medi-Cal Claims Customer Services Representatives I, II or III, Claims & Appeals Specialists, and Claims Resolution Coordinators. Supervises the customer service work-flow. Supports Claims Customer Service Specialist and customer service functions. Maintains CIF and adjustment inventories within established department guidelines. Maintains telephone response rates within established department guidelines. Reviews quality control audits with Customer Service staff to ensure compliance within established department guidelines, policies, and procedures. Identifies errors and deficiencies; develops and implements corrective action and training plans for staff. Interviews and participates in the selection of qualified candidates for the Claims Specialist and Claims Customer Service positions. Evaluates performance and provides developmental opportunities to staff. Provides training of new staff as appropriate. Counsels performance problems or issues when needed. Reviews and signs time cards. Reviews department policies and procedures, recommends changes for more efficient operations, communicates changes, and updates to staff when appropriate. Monitors and prepares production statistics and related reports for the Manager's/Director's review. Leads or participates in special projects and assignments as needed. Participates in provider meetings, both on and off site as required. Reviews and signs claim adjustment and high dollar claims within established guidelines. Other duties as assigned. Qualifications Education and Experience Bachelor's degree in Health Care Services preferred; minimum three (3) years supervisor experience in a claims or customer service environment preferred; or equivalent combination of education and experience. Prior Medi-Cal or Medicare claims experience preferred. Special Skills, Licenses and Certifications Thorough knowledge of CPT, HCPC procedure coding, ICD-9 diagnostic coding, and medical terminology. Expertise in automated claims procedures and related problem resolution. Typing speed 30 wpm and proficient use of 10-key calculator preferred. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Performance Based Competencies Excellent oral and written communication skills. Excellent interpersonal skills with ability to lead and supervise staff to effectively complete assignments within established time frames and standards. Ability to effectively exercise good judgment and handle sensitive issues with frequent interruptions. Good organization skills. Work Environment And Physical Demands Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. More than 70% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 10 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated. HIRING RANGE: $45.04 - $56.30 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Responsibilities

Supervise the Medi-Cal Claims Customer Service team to ensure high-quality customer service delivery. Oversee workflow, conduct quality audits, and implement training and corrective actions as needed.