The job profile for this position is Intake Care Supervisor, which is a Band 3 Management Career Track Role.
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JOB PURPOSE
The claims supervisor directs the activities of staffs who are adjudicating and finalizing Pre-authorizations and claims. As a subject matter expert to take an initiative in assisting team requirements pertaining to the operational software and tasks related to the policy coverage terms.
RESPONSIBILITIES AND DUTIES
- Perform job supervisory duties to assure proper training, instructions, and development of staff.
- Control claims cost by all permissible, equitable, fair means.
- Closely coordinate with the Reporting Manager-Claims on staff performance reviews and leave scheduling;
- Delegate and oversee activities performed by claims examiners.
- Daily monitoring of pipelines and queues.
- Identify training requirements within the team and perform training sessions.
- Responsible in maintaining the assigned TAT of the respective teams and ensuring the optimal utilization of resources.
- Address any internal grievances and escalate to reporting manager if required.
- Responsible for reporting of identified Claims Fraud, Waste and Abuse trends and escalating to concerned parties
- Escalate any identified software issues to the reporting manager and IT POC as required.
- Identify gaps in performance and offer coaching to officers as needed.
- Proper communication and identifying training requirements within the team.
- Strictly applies reporting manager’s Claims directions.
- Carry out any other related functions as directed by the company management.
KNOWLEDGE, SKILLS AND EXPERIENCE
- University degree in any discipline of medical/Para-medical science from a reputable university.
- Strong industry knowledge (healthcare / insurance).
- Should be a team-player with an aptitude for customer service.
- Excellent oral and written communication skills.
- Must be computer literate.
- Excellent command of the English language.
- Ability to work under pressure.
- 2+ years’ experience in the healthcare industry / hospitals.
- Business acumen, persuasive skills and ability to lead a team.
- Strong decision-making ability; Good understanding of internal processes and software systems.
COMMUNICATIONS AND WORKING RELATIONSHIPS
Ensure seamless communication between all departments for the smooth operations and to achieve the organizational objective. Establish strong internal & external communication.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
