• Claims Production Supervisor

    Job Locations US-RI-Smithfield
    Req No.
    2018-9259
    Department
    Claims
    Type
    Regular Full-Time
  • Overview

    This position’s responsibility is to guide the claims staff in ensuring that claims are processed according to state and federal regulations and meet NHPRI’s contractual obligations. 

    Responsibilities

    • Oversee workflow management for the teams to ensure acceptable backlogs are maintained and claims are processed in a timely manner.
    • Ensure that the Claims staff is following claims policies and procedures on a day-to-day basis. Coordinate the daily activities within the department for the Claims staff.
    • Train new staff and new staff moving into new positions within the department. Conduct on-going cross-training of existing staff.
    • Assists with maintaining department statistics to monitor claims inventory for Senior Leadership and to assist with departmental staffing needs.
    • Oversees any offshore activity related to scanning and/or claims processing.
    • Provides functional expertise to all staff responsible for any aspect of claims processing.
    • Oversee the EDI process within the department to ensure process is working and when necessary will distribute work to staff.
    • Act as a departmental resource.
    • Perform quality control as required.
    • Perform claims analysis and all related job functions as required by the workload and the department Manager.
    • Works with the Manager and Director to recommend changes, develop or modify policies and procedures to enhance team’s and NHPRI performance.
    • Special projects as assigned.
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

    Qualifications

    • High School graduate or equivalent
    • Associate or Bachelor degree (preferred)
    • 3 – 5 years claims experience is required with 1 year minimum experience as claims analyst/examiner
    • Prior Supervisory experience 
    • Claim Quality Background
    • Prior experience with COB/TPL, appeals and claims auditing a plus;Strong presentation and written communication skills a must (writing samples will be requested)
    • Strong PC abilities in Microsoft Word and Excel
    • Excellent Customer service skills
    • Ability to effectively prioritize and execute tasks in a high-pressure environment is crucial
    • Mathematical skills and detail accuracy
    • Team Player
    • Certified Professional Coder (CPC) preferred 

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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