Job Description

At our company, our mission starts with our people. Guided by our HEART values of Humility, Excellence, Accountability, Respect, and Trust, we strive to create a workplace where teammates feel valued, supported, and empowered to do their best work every day.

As a Claims Supervisor, you’ll manage and direct the activities of a team of Claims Examiners and Claims Benefits, and handle claims processing concerns and issues requiring a high degree of appropriate knowledge, creativity, research and communication with internal and external resources to achieve timely resolution.

Job Duties & Responsibilities

• Proactively identifies and solves problems with timely resolution of complex issues referred by Claims Examiners and Claims Benefits Specialists
• Provides daily management support to Claims Examiners and Claims Benefits Specialists
• Obtains daily stats of each team member’s production goals to review with Manager, and develops a successful plan to increase each team member’s production while maintaining accuracy
• Responds to a claims processing question rapidly and accurately to meet the Claims Examiners and Claims Benefits Specialists expectations of timely processing of claims in queue via email or discussion. Resolves all questions on a daily basis accurately with a result of no pending claims or penalties
• Monitors and audits specified criteria based on claims training to assure perception of policy and procedures guidelines was comprehended. Coordinates with trainer/manager a resolution to problems identified post training where a comprehension gap can be diminished
• Assists the Manager with conducting performance reviews and team meetings
• Assists Manager in identifying opportunities for process and service improvement initiatives, and participates in the development and implementation of action plans
• Compiles and reviews Internal reports to identify any incorrect claims payment for all product lines for the weekly check run. Completes actual check review process and forwards for check process on same day as check push every week
• Serves as initial point of contact for all issues regarding work schedules

Qualifications

• High school diploma or GED required
• 5 years of claims processing experience required

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.