Claims Processing Supervisor

AllCare Health | Claims Department

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options.

Summary of the Position

The Claims Processing Supervisor ensures that internal and external departmental performance requirements are consistently met. This role oversees the day-to-day activities of the Claims Processing team, assigns work and coordinates efficient workflows to meet contractual and operational requirements, and serves as a hands-on resource for staff regarding training, questions, and claims processing best practices.

Essential Duties

1. Provides one-on-one support and initial training for new hires and facilitates monthly mandatory training sessions for Claims Processing staff.

2. Establishes and maintains a professional, supportive, and provider service-oriented workplace culture with high standards for individual and team performance.

3. Maintains production and quality monitoring logs and reports for individual employees and overall departmental performance.

Job Duties

• Supports and contributes to AllCare’s mission, vision, and values.

• Maintains and monitors internal audit procedures to ensure staff compliance with departmental policies, procedures, and quality standards.

• Ensures claims processing procedures are followed consistently and provides coaching or retraining as needed.

• Maintains compliance with departmental policies and procedures related to HIPAA and protected health information (PHI).

• Reviews, develops, maintains, and updates claims processing procedures, reference materials, and training resources.

• Maintains a working knowledge of the duties, processes, and workflows performed by all positions supervised.

• Organizes team workflow and assigns responsibilities to ensure appropriate coverage, including during staff absences.

• Monitors individual and team productivity and quality and provides regular, constructive feedback.

• Identifies and addresses employee performance, attendance, and workplace concerns in accordance with organizational policies and procedures.

• Conducts performance evaluations for direct reports.

• Maintains clear and accurate documentation of employee performance discussions, coaching, and disciplinary actions.

• Identifies and communicates system needs, process improvement opportunities, operational concerns, and staff-related issues to department leadership.

• Demonstrates professional and respectful communication and behavior when working with employees, leadership, providers, and other stakeholders.

• Maintains punctual, regular, and predictable attendance.

• Works collaboratively within the department and across teams to support effective claims operations.

• Respectfully receives and follows direction from the Sr. Claims Processing Manager and/or VP, Claims Administration & Payment Integrity.

• Completes all required training, including assigned Relias Learning Management System (LMS) training.

• Performs other duties as assigned.

On-Call Responsibilities

This position does not have any on-call responsibilities.

Supervisory Responsibilities

Directly supervises approximately 9–11 employees within the Claims department. Carries out supervisory responsibilities in accordance with organizational policies and applicable laws. Responsibilities include interviewing, hiring, onboarding and training employees; planning, assigning, and directing work; monitoring and evaluating performance; providing coaching and corrective action when appropriate; addressing employee concerns; and supporting the resolution of workplace issues.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, with or without reasonable accommodation. The requirements below are representative of the knowledge, skills, and abilities necessary for the position.

Education

• High school diploma or equivalent required.

• Bachelor’s degree from a four-year college or university preferred; or an equivalent combination of education and experience.

Experience

• Two or more years of experience in managed care, Medicare, and/or Medicaid claims processing required.

• Working knowledge of core claims concepts, including co-pays, deductibles, co-insurance, coordination of benefits, and claims adjudication practices.

• Extensive knowledge of medical terminology and coding systems, including ICD-9, ICD-10, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Diagnosis Related Group (DRG), Resource Utilization Groups (RUG), and Health Insurance Prospective Payment System (HIPPS) codes.

• Knowledge of CMS-1500, UB-04, and other applicable paper and electronic claim forms.

• Experience researching and resolving claims errors, refunds, and adjustments.

• Prior supervisory, lead, or training experience preferred.

Certificates, Licenses, and/or Registrations

• AAPC certification such as CPC, CPB, or CPMA required within 12 months of hire. Equivalent nationally recognized coding, billing, or medical auditing certification may be considered.

Technical Skills

• Strong knowledge of healthcare claims processing and managed care operations.

• Strong organizational and time-management skills with the ability to manage competing priorities and deadlines.

• Proficiency with Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel.

• Knowledge of and ability to maintain compliance with HIPAA and PHI requirements.

• Ability to organize projects and initiatives into measurable tasks and track progress through completion.

• Ability to collect, review, and interpret data to identify trends, resolve problems, and support operational decisions.

• Ability to research and synthesize information from multiple sources.

• Knowledge of customer service and service recovery best practices.

• Ability to communicate effectively and professionally when addressing escalated or challenging situations.

• Knowledge of training best practices and adult learning principles.

• Ability to develop and deliver effective employee training.

• Ability to identify opportunities for process, workflow, quality, and operational improvement.

Interpersonal & Leadership Skills

Trust: Promotes honesty, transparency, accountability, and diligence. Builds trust with employees and leadership and involves others appropriately in planning and decision-making. Able to make and communicate difficult decisions in the best interest of AllCare Health.

Innovation: Adapts effectively to change and helps employees navigate changes in processes, systems, and expectations. Proactively identifies solutions to challenges and looks for opportunities to improve team and departmental performance.

Relationships: Builds positive and productive working relationships. Listens to understand the needs and concerns of others, responds in a timely manner, and provides clear and helpful information. Recognizes and appropriately addresses challenging team dynamics.

Voice: Recognizes the value of differing perspectives and promotes respectful communication and collaboration across differences. Demonstrates awareness of how implicit bias, identity, power, and privilege may impact individuals, teams, organizations, and systems.

Language Skills

Ability to read, analyze, and interpret business materials, professional journals, technical procedures, and governmental regulations. Ability to prepare reports, business correspondence, procedures, and other documentation. Ability to effectively present information and respond to questions from employees, leaders, providers, customers, and other stakeholders.

Mathematical Skills

Ability to perform calculations involving percentages, proportions, rates, and other mathematical concepts commonly used in claims processing, reporting, and performance monitoring.

Computer Skills

This position requires proficiency with computer systems and applications used for claims processing, database entry, reporting, email communication, document creation, presentations, and other business functions. Must be able to learn and effectively use systems and technology required for the position.

Reasoning Ability

Ability to solve practical problems, analyze information, exercise sound judgment, and work with a variety of variables in situations where limited standardization may exist. Ability to interpret instructions provided in written, oral, diagrammatic, or schedule-based formats.

Physical Demands & Work Environment

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this position, the employee is regularly required to sit, use their hands, and communicate verbally. The employee is occasionally required to stand, walk, and reach with their hands and arms. The noise level in the work environment is typically moderate.

The physical demands and work environment described above are representative of those encountered while performing the essential duties of this position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

• Employee must be able to work onsite as required.

• Employee may be eligible to work from a home office in accordance with departmental and organizational requirements.

Company Overview

AllCare Health is incorporated as an Oregon Benefit Corporation and has maintained Certified B Corporation® status since 2017. As such, AllCare Health considers its impact on the community, society, and the environment in its business decisions.

AllCare Health headquarters are located in Grants Pass in Southern Oregon along the Rogue River, surrounded by mountains, forests, small farms, and scenic views. The region offers access to outdoor recreation, including rafting, fishing, hiking, biking, wineries, outdoor concerts, the Oregon Coast, redwood forests, and more.

The AllCare Health Family of Businesses Is Guided by Our Corporate Principles

Purpose | Working together with our communities to improve the health and well-being of everyone.

Values | Trust, Innovation, Relationships, and Voice.

Vision | Thriving, Inclusive, and Equitable communities.

Brand Promise | Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered on belonging and serving our growing community. If you are excited about this position but your experience does not align perfectly with every qualification listed, we encourage you to apply. You may be the right candidate for this role or another opportunity with AllCare Health.

If you need an accommodation, assistance with the application process, or this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disability status, genetic information, or any other status protected by applicable law.