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Job Description
Resp & Qualifications PURPOSE:
Supervise and provides daily direction to multi-functional team members regarding training and development, policies, procedures, and work production quantity and quality. Functional areas may include but not limited to claims processing, inventory management, cross-team collaboration and management of a direct report team of approximately 15 claims processors. Reviews and resolves complex claims issues not resolvable by subordinates.
ESSENTIAL FUNCTIONS
Supervise employee outcomes by training, assigning, scheduling, coaching, and counseling employees; communicating job expectations; planning, monitoring, and appraising job contributions; adhering to policies and procedures. Meets operational standards by contributing information to strategic plans and reviews; implementing production, productivity, quality, and inventory management; resolving problems; identifying system improvements. Maintains customer service objectives by monitoring daily operations; resolving claims that require manual review or technical support, enrollment or billing related customer issues. Consistently reviews systems and makes necessary adjustments where needed, including resources/staffing. Researches and resolves escalated claims that have not been resolved by Claims or quality staff. Maintains and improves departmental operations by monitoring system performance; identifying and resolving operations problems; supervising process improvement and quality assurance programs; installing upgrades. Prepares claims performance reports by collecting, analyzing, and summarizing data and trends. Improves claims management and leadership job knowledge by attending educational workshops.
SUPERVISORY RESPONSIBILITY
This position manages people.
QUALIFICATIONS
Education Level:
High School Diploma or GED Experience:
3 years related professional experience with demonstrated leadership skills. Must have proficiency in the service, claims or enrollment & billing area.
Preferred Qualifications:
Bachelor's Degree Knowledge, Skills and Abilities (KSAs) Knowledge of claims operations and work flows. Strong presentation skills. Highly proficient in Microsoft Office programs and Salesforce. Excellent communication skills both written and verbal. Ability to plan, review, supervise, and inspect the work of others. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range:
$63,648 - $131,274 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Federal Disc/Physical Demand Note:
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship
