Supervisor ITS Claims (REMOTE)

<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, USA


<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>

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Competitive Compensation and Benefits Package

Overview: <br /> <p><strong>THIS POSITION CAN BE REMOTE ACROSS THE US!</strong></p> <p><strong>SUMMARY:</strong>&nbsp;&nbsp;&nbsp;</p> <p>The ITS Claims Supervisor is responsible for ensuring the accuracy and timeliness of ITS claims processing for the BlueCard program. The Supervisor will be responsible for&nbsp;and delegating components to members of the team, including him/herself. The Claims Supervisor often provides information to the Claims Manager or updates the company on the team&rsquo;s progress in meetings or through regular email contact or reports.&nbsp;This role also requires effectively leading and participating in discussions with staff, management, providers, internal teams and business process outsourcing vendors as well as through reporting and quality monitoring and oversight activities with the expectancy of establishing, leading and implementing process improvement initiatives that will strengthen claims quality and performance leading to operational excellence, continuous service improvement for our customers and maintaining compliance. This role is also responsible for managing all Plan-to-Plan activities as well as developing training materials for BlueSquared.&nbsp;</p> <br /><br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards or remotely. 20% travel may be required as needed.</p>
Responsibilities: <br /> <ul> <li>Supervise a team of ITS Claims Specialists and others claim roles</li> <li>Approve and manage employee time sheets</li> <li>Performs and holds 1:1 and Team meetings on a regular and consistent basis</li> <li>Work with and coordinate with other Blue partners on Global Certification.</li> <li>Work with claims processor on testing and timelines of new Plan Connextion releases.</li> <li>Establish a mutual partnership with other ITS plans.&nbsp;</li> <li>Monitoring of ITS claim files uploaded in systems.</li> <li>Identify and report trends and issues detected and provide issue resolution in error processing and escalated issues.</li> <li>Support and participate in system testing and requirements gathering related to operational readiness updates based on system enhancements, CMS software releases and as needed.</li> <li>Provide and implement quality and process improvement initiatives; assist in the creation and implementation of policies and procedures and workflows.</li> <li>Support all CMS and internal audit activities as needed.</li> <li>Develop and maintain all training materials related to BlueSquared activities</li> <li>Deliver standup training of BlueSquared materials to employees and vendors as needed</li> <li>Manage all aspects of Plan to Plan activities including developing scripts and desk level procedure documentation</li> <li>Develop all call scripts for Plan to Plan activities and draft all other needed collateral related to Plan to Plan processing</li> <li>Monitor Plan to Plan lines as needed for quality as well as incoming volume</li> <li>Provide reporting on Plan to Plan metrics</li> <li>Serve as primary point of contact for ITS escalated issues</li> <li>Develops and improves workflows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.</li> <li>Identifies and/or analyzes business problems and devise procedures for solutions to the problems.</li> <li>Develops and maintains an effective working relationship with customers.</li> <li>Effectively leads projects/teams in order to produce desired results.</li> <li>Responsible for corporate communication of project results.</li> <li>Work with Human Resources to coordinate interviewing, hiring, and development of new hires to department</li> </ul> <p>&nbsp;</p> <p><strong>DIRECTION EXERCISED:<br /><br /></strong></p> <ul> <li>Directly supervises non-exempt and exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp;</li> <li>Responsibilities include but are not limited to effectively interviewing, hiring and training employees, planning, assigning and directing work, appraising performance, rewarding and counseling employees, addressing complaints and resolving problems, supporting and encouraging the engagement process.</li> </ul> <br /><br /><br />This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
Requirements: <br /> <p><strong>EDUCATION:<br /><br /></strong></p> <ul> <li>Bachelor&rsquo;s degree in a related field.</li> <li>Relevant combination of education and experience may be considered in lieu of degree.</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <br /> <p><strong>EXPERIENCE:<br /><br /></strong></p> <ul> <li>Five years experience of Advantasure Platform systems experience with demonstrated technical knowledge that provides the necessary skills, knowledge and abilities.</li> <li>Claims background in a Medicare Advantage Organization preferred.</li> <li>Two years of supervisory experience required.</li> <li>Previous experience of claims analyst using facets, or equivalent, for claims and enrollment systems preferred.</li> </ul> <br /> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:<br /><br /></strong></p> <ul> <li>Knowledge of ITS claims processing.</li> <li>Excellent verbal and written communication and interpersonal skills.</li> <li>Strong analytical and critical thinking skills with a high attention to detail.</li> <li>Must be able to be flexible in a fast-paced environment and adaptable to change.</li> <li>Ability to work independently as well as with all levels of staff, leadership and external partners and vendors.</li> <li>Ability to effectively prioritize, coordinate and lead activities.</li> <li>A strong working knowledge of Microsoft Office products.</li> </ul>