Supervisor, Claims & Configuration

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Southfield, MI


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p>

keywords: position summary,teamwork,management,quality assurance,design,claims,develop,experience,analysis,education,technical,skills,teamwork


Competitive Compensation and Benefits Package

Overview: <p>Claims &amp; Configuration Supervisor will be responsible for managing the implementation of both of Advantasure systems to correctly adjudicate claims based on partner plan bid and provider contracts. This position will be responsible for oversight over the claims and configuration specialists dedicated to setting up new partner plans.&nbsp;</p>
Responsibilities: <ul> <li>Manage a team of three to four FTEs and Contractors</li> <li>Participate and provide subject matter expertise to internal and external clients on standard CMS covered benefits and payment guidelines</li> <li>Design and lead the approach of building, testing, and maintenance of new plan benefits and provider contract configuration in core admin system</li> <li>Responsible for leading testing of claims in multiple real-life scenarios to ensure accuracy in provider reimbursements and member cost share based on benefit design &amp; provider contracts configuration and CMS regulations</li> <li>Develop and or improve business processes and workflows within the cross functional claims team (Provider data management, payment &amp; recoveries, ITS, EOBs) to improve client satisfaction, decrease implementation costs, and improve overall quality</li> <li>Delivers presentations as needed to help customer understand the end to end claims adjudication process and pertinent configuration implementation approach and standard capabilities</li> <li>Participate in internal SOC 1 and 2 controls audit</li> <li>Assist implementation product owner in defining the implementation backlog and story grooming as needed</li> <li>Assists plan operations and client personnel by answering questions, supplying information, and training in the area of claims configuration and setup</li> <li>Develops and maintains an effective working relationship with both internal and external customers</li> <li>Effectively leads projects/teams in order to produce desired results</li> <li>Responsible for corporate communication of project results</li> <li>Develops and implements desk levels and policies and procedures for deviations of Advantasure standard processes</li> </ul>
Requirements: <p><strong>EDUCATION:</strong></p> <p>Bachelor&rsquo;s degree in Business Administration, Computer Science, Information Technology, Health Care or other related field. Relevant combination of education and experience may be considered in lieu of degree. Certification or progress toward certification is highly preferred and encouraged.</p> <p><strong>EXPERIENCE:</strong></p> <p>Five years of Advantasure experience with demonstrated technical knowledge that provides the necessary skills, knowledge and abilities. Claims background in a Medicare Advantage Organization preferred. Two years of supervisory experience required. Previous experience of benefit/claims configuration of facets, or equivalent, for claims and enrollment systems preferred.&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Ability to do annual reviews.</li> <li>Ability to plan, organize, direct, and control projects.</li> <li>Ability to lead and contribute to process improvement projects.</li> <li>Working knowledge of PC applications and/or mainframe required.</li> <li>Excellent analytical, organizational, and problem solving skills.</li> <li>Ability to effectively exchange information clear and concisely, present ideas, and respond to questions as appropriate, both in oral and written communications.</li> <li>Project work experience preferred as the job will include some project work, meeting deadlines, understanding requirements, and supporting business deliverables.</li> <li>Ability to work as both a team player as well as an individual contributor with limited supervision.</li> <li>Ability to manage multiple priorities.</li> <li>Significant creativity ability required to utilize system capabilities to meet benefit design.</li> <li>Ability to develop, implement, and monitor policies and procedures.</li> <li>Technical knowledge of insurance administration, claims management, or relevant insurance expertise.</li> <li>Strong interpersonal and superior communication skills, including verbal and professional writing.</li> <li>Strong report preparations and presentation capability.</li> <li>Ability to analyze and interpret documents for accuracy in reference to technical, legal, and financial information.</li> <li>Ability to quickly make decisions and comprehend the consequences of various problem situations and take appropriate actions and/or refer problems for necessary decision making.</li> <li>Ability to organize and prioritize multiple assignments.</li> <li>Ability to work tight timelines when necessary.</li> <li>Ability to work with minimal supervision.</li> <li>Ability to identify workflow options to create and improve investigation process.</li> <li>Ability to continually exercise discretion and independent judgment in matters of significance.</li> <li>Ability to identify industry trends and present emerging ideas for change management.</li> </ul> <div id="gtx-trans" style="position: absolute; left: -80px; top: 26px;">&nbsp;</div>