Supervisor Claims Operations

Supervisor FEP Claim Operations

The Supervisor of Claims Operations supervises daily activities of specific market segment unit (FEP) and ensures accurate and timely processing of all claims and post payment adjustments. Oversees review of claims for benefit determination, other party and subscriber liability. Supervises examiners/analysts in providing prompt and accurate information and courteous service to all internal and external customers.

Responsibilities

• Plans, controls, coordinates daily workflow, maintaining high rate of quality and productivity without excessive overtime
• Supervises examiners/analysts in the accurate and timely processing of medical claims and all related procedures. Supervises processing of necessary adjustments on paid claims. Maintains an effective, on-going quality control program and ensures that all operational standards of performance established by the account, our Plan, Blue Cross and Blue Shield Association, etc., are met.
• Ensures that prompt, accurate information and courteous service is provided to all internal and external customers via all forms of communication.
• Prepares production reports for management. Maintains accurate and current records of all claims and inquiries received, processed, and pended.
• Reviews work procedures, work output and automated programs to detect problem areas and opportunities for improvement. Initiates and/or assists with projects and procedural changes affecting the specific workstream, including major system changes to maintain and enhance the efficient processing of claims. Makes recommendations and develops and implements new or revised methods or procedures.
• Monitors performance of subordinates, working to develop and enhance their skills. Administers corrective action in accordance with policy when appropriate.
• Performs other appropriate duties as assigned.