The Job logo

What

Where

Unit Mngr - Knowledge Services

ApplyJoin for More Updates

You must Sign In before continuing to the company website to apply.

Smart SummaryPowered by Roshi
The Claims Supervisor is responsible for providing support, direction, and supervision to Claims Examiners. This position monitors and supervises various processes throughout the claims cycle and processes claims for assigned groups.

Job Description

Claims Supervisor

Summary: Under the supervision of the Claims Manager, the Claims Supervisor is responsible for providing support, direction and supervision to Claims Examiners. This position also monitors and supervises various processes throughout the claims cycle and may process claims for assigned groups.

 

Essential Functions:

  • Supervision and Leadership
  •  Responds to examiner questions and tracks question trends
  •  Assists with providing training for new and existing examiners and assistants
  •  Provides ongoing feedback and support to improve performance of direct reports
  •  Prepares and facilitates performance reviews for direct reports
  •  Reviews and approves time cards and PTO requests for direct reports
  •  Assists with the identification and selection of new employees
  •  Communicates clearly and concisely, with sensitivity to the needs of others

 

Claims 

  •  Monitors claims inventory daily; manages inventory to ensure claims are being processed in a timely manner
  •  Processes overpayments, underpayments, and refund checks
  •  Reviews appeals and assists with determination
  •  Reviews and approves weekly claim batches
  •  Monitors weekly pend report process
  •  Monitors weekly pre-check register process
  •  Assists with researching escalated provider services/client services claims inquiries
  •  Assists with organization and facilitation of department meetings

 

Additional Functions: 

  •  Assists with special projects, as requested
  •  Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
  • Maintains courteous, helpful and professional behavior on the job
  •  Establishes and maintains effective working relationships with co-workers
  •  Follows and ensures departmental compliance with all Policies and Procedures and HIPAA regulations
  •  Maintains knowledge and understanding of current Medicare claims processing guidelines
  •  Attends continuing education seminars/training as requested
  •  Maintains a safe working environment
  • Supervisory Responsibility: Provides supervision for assigned remote Claims Examiners.

Travel:  None

Knowledge, Skills and Abilities:

  •  Educational requirements include a High School Diploma or equivalent. A minimum of three years of claims processing experience is preferred. A minimum of one year of supervisory experience is required, preferably in health plan operations.
  •  Solid understanding of CMS-1500 & UB-04 guidelines
  •  Strong working knowledge of CPT, ICD-10, and HCPCS coding, including modifiers
  •  Familiarity with APC and DRG reimbursement
  •  Knowledge of EDI claims
  •  Knowledge and experience using current computer technology, including experience with Excel and Word.
  •  Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
  •  Skilled in data analysis and problem solving using defined methodologies
  •  Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
  •  Ability to be an advocate of the 32 Fundamentals
  •  Ability to work independently with minimal supervision
  •  Ability to independently follow through on projects
  •  Ability to communicate professionally, clearly and effectively, verbally and in writing
  •  Ability to prioritize effectively
  •  Ability to consistently multitask

 

Physical Demands & Requirements :

  •  Communicates in person and via telephone with staff, participants, customers, and vendors
  •  Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
  •  Remains stationary for extended periods of time
  •  Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
  •  Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
  •  Occasional reaching to retrieve shelved items

 Occasional bending/stooping

 

Work Environment :

  •  This job operates in a home office environment
  •  No substantial exposure to adverse environmental conditions is expected.
  •  Moderate pressure to meet scheduled appointments and deadlines

Supervised by:    Claims Manager

 

Skills

PRIMARY COMPETENCY : Healthcare PRIMARY SKILL : Non-Voice PRIMARY SKILL PERCENTAGE : 100

 

Set alert for similar jobsUnit Mngr - Knowledge Services role in Bangalore Urban, India
Mphasis Logo

Company

Mphasis

Job Posted

9 months ago

Job Type

Full-time

WorkMode

On-site

Experience Level

3-7 years

Category

IT Services and IT Consulting

Locations

Bangalore Urban, Karnataka, India

Qualification

Bachelor

Applicants

Be an early applicant

Related Jobs

Mphasis Logo

UNIT MNGR - KNOWLEDGE SERVICES

Mphasis

Bangalore Urban, Karnataka, India

Posted: 9 months ago

Job description Claims Supervisor Summary: Under the supervision of the Claims Manager, the Claims Supervisor is responsible for providing support, direction and supervision to Claims Examiners. This position also monitors and supervises various processes throughout the claims cycle and may process claims for assigned groups. Essential Functions: Supervision and Leadership  Responds to examiner questions and tracks question trends  Assists with providing training for new and existing examiners and assistants  Provides ongoing feedback and support to improve performance of direct reports  Prepares and facilitates performance reviews for direct reports  Reviews and approves time cards and PTO requests for direct reports  Assists with the identification and selection of new employees  Communicates clearly and concisely, with sensitivity to the needs of others Claims   Monitors claims inventory daily; manages inventory to ensure claims are being processed in a timely manner  Processes overpayments, underpayments, and refund checks  Reviews appeals and assists with determination  Reviews and approves weekly claim batches  Monitors weekly pend report process  Monitors weekly pre-check register process  Assists with researching escalated provider services/client services claims inquiries  Assists with organization and facilitation of department meetings   Additional Functions:   Assists with special projects, as requested  Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees Maintains courteous, helpful and professional behavior on the job  Establishes and maintains effective working relationships with co-workers  Follows and ensures departmental compliance with all Policies and Procedures and HIPAA regulations  Maintains knowledge and understanding of current Medicare claims processing guidelines  Attends continuing education seminars/training as requested  Maintains a safe working environment Supervisory Responsibility: Provides supervision for assigned remote Claims Examiners. Travel:  None Knowledge, Skills and Abilities: Educational requirements include a High School Diploma or equivalent. A minimum of three years of claims processing experience is preferred. A minimum of one year of supervisory experience is required, preferably in health plan operations.  Solid understanding of CMS-1500 & UB-04 guidelines  Strong working knowledge of CPT, ICD-10, and HCPCS coding, including modifiers  Familiarity with APC and DRG reimbursement  Knowledge of EDI claims  Knowledge and experience using current computer technology, including experience with Excel and Word.  Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels  Skilled in data analysis and problem solving using defined methodologies  Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency  Ability to be an advocate of the 32 Fundamentals  Ability to work independently with minimal supervision  Ability to independently follow through on projects  Ability to communicate professionally, clearly and effectively, verbally and in writing  Ability to prioritize effectively  Ability to consistently multitask Physical Demands & Requirements :  Communicates in person and via telephone with staff, participants, customers, and vendors  Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer  Remains stationary for extended periods of time  Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects  Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy  Occasional reaching to retrieve shelved items  Occasional bending/stooping Work Environment :  This job operates in a home office environment  No substantial exposure to adverse environmental conditions is expected.  Moderate pressure to meet scheduled appointments and deadlines Supervised by:    Claims Manager   Skills PRIMARY COMPETENCY : Healthcare PRIMARY SKILL : Non-Voice PRIMARY SKILL PERCENTAGE : 100

Mphasis Logo

Module Lead - Automation

Mphasis

Bangalore Urban, Karnataka, India

Posted: 9 months ago

Job Description Who are we looking for? A mid-senior level Tester for our esteemed Insurance Client.   Technical Skills: 1. Manual Testing Experience 2. Automation Testing Experience 3. Visual Studio/Eclipse 4. Selenium with Java and JavaScript 5. Test NG 6. Knowing WDIO and Node JS is a MUST 7. Hands on Knowledge to use the “POSTMAN” tool for the queries. 8. Testing REST API’s and WebServices.   Process Skills:  Capable of analyzing requirements and develop software as per project defined software process  Develop and peer review of LLD (Initiate/ participate in peer reviews)  Ability to execute test plans, create test cases test data and contribute to appropriate software (including programming languages) development life cycle methodology and application of specialized business and technical knowledge.   Behavioral Skills :  Resolve technical issues of projects and Explore alternate designs  Participates as a team member and fosters teamwork by inter-group coordination within the modules of the project.  Effectively collaborates and communicates with the stakeholders and ensure client satisfaction  Train and coach members of project groups to ensure effective knowledge management activity. Certification:   Skills PRIMARY COMPETENCY : Testing PRIMARY SKILL : Test Automation-Selenium PRIMARY SKILL PERCENTAGE : 80 SECONDARY COMPETENCY : Testing SECONDARY SKILL : Functional / Manual Testing SECONDARY SKILL PERCENTAGE : 20