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Claims Supervisor, South San Francisco, CA


Health Plan of San Mateo

Supervisor

South San Francisco, CA

December 14, 2018


CLAIMS SUPERVISOR

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Claims Supervisor. The Claims Supervisor assists the claims manager with the daily oversight and management of the claims processing and adjudication processes. The supervisor will direct and support the day to day activities of assigned staff and monitor the accurate and timely resolution of disputes for all lines of business.

The essential duties and responsibilities will include the following:

  • Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures and productivity standards. Complete performance evaluations in a timely manner.
  • Ensure departmental goals are met; develop strategies and schedules for meeting stated goals.
  • Assist claims manager develop policies and procedures, job aids, reference materials and/or desk procedures for all unit workflows.
  • Monitor and review the examiners workload and productivity; provide direction and backup as needed.
  • Continuously monitor and evaluate unit performance, taking steps to improve the efficiency and quality of unit operations.
  • Recommend opportunities for improvement identified through trend analysis.
  • Implement necessary policy and regulatory changes.
  • Communicate newly-identified and potential issues to claims manager or other departments as necessary.
  • Maintain knowledge of industry trends, bet practices and regulatory requirements.
  • Facilitate and document meetings.
  • Perform other duties as assigned.

Requirements

Education and Experience: Five years of medical claims experience with at least two (2) years in a supervisory role. Bachelor’s degree in related field preferred.

Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Medi-cal and Medicare program guidelines CPT, HCPCS, revenue and ICD-10 coding

Ability to: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Analyze and problem solve, making good decisions. Adapt to changes in requirements/priorities for daily and specialized tasks. Collaborate with multiple parties to solve problems and solve problems independently. Provide feedback in a constructive and growth-oriented manner.

Compensation and Benefits

Starting Compensation Range: - Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

How to Apply

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.

Submissions without a Cover Letter and Salary Expectations may not be considered.


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