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Claims Quality Supervisor, South San Francisco, CA


Health Plan of San Mateo

Supervisor

South San Francisco, CA

November 7, 2019


CLAIMS QUALITY SUPERVISOR

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Claims Quality Supervisor. The Claims Quality Supervisor acts as a facilitator for department improvements and oversight of claims performance and quality. The position is responsible for developing claims QA policies, procedures, and standards, overseeing all claims QA operations and directly supervising claims audit staff and providing them with feedback regarding production and quality of the claim auditing completed. The supervisor is also responsible for collaborating with claims management and training staff to evaluate and determine training needs for the claims department and report out quality results, trending and recommendations for improvement.

The essential duties and responsibilities will include the following:

  • Supervises all quality assurance functions to ensure work is completed on a timely and accurate basis
  • Ensures an effective claims audit program
  • Tracks progress and communicates audit results/status on a regular basis to all impacted parties
  • Identifies operational gaps and recommends enhancements for quality improvement
  • Serves as subject matter expert for dedicated lines of business on quality improvement, root cause analysis and action plans
  • Supervises staff including determining staffing needs, setting goals, interviewing, selecting, coaching, and evaluating the performance of all direct reports
  • Creates and updates unit procedures, workflows, and resource material.
  • Identifies issues and problems, develops solutions and recommendations, including new policies and procedures
  • Ensure that claims are compliant with applicable statutes, regulations and company standards
  • Inform management of any quality issues in a timely manner
  • Contributes to and supports quality initiatives by planning, communicating, and encouraging team and individual contributions
  • Perform other duties as assigned.

Requirements

Education and Experience: Minimum of five (5) years’ experience in medical insurance claims required with at least two (2) years in a leadership role. Bachelors' degree in related field or equivalent combination of education and experience required

Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Medi-Cal and/or Medicare program billing guidelines and standard billing code sets.

Ability to: Demonstrated ability in working cooperatively with co-workers and across departments. Ability to communicate effectively, both orally and in writing. Work as part of a team and support team decisions. Adapt to changes in requirements/priorities for daily specialized tasks. Collaborate with internal staff to solve problems.

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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