Title: Health Insurance Claims Supervisor

Location: Menasha, WI 54952, USA

Brookfield, WI 53005, USA

Hybrid

Claims Production

Full-time

Requisition #: CLAIM002306

Job Description:

Network Health's success is rooted in our mission to enhance the life, health, and wellness of the people we serve. This mission drives every decision we make - including the selection of individuals who join our growing team.

We are seeking a Claims Supervisor to provide leadership and oversight of the daily operations within our Claims Production Department, including outsourced vendor management across multiple lines of business. This role plays a critical part in ensuring operational efficiency, regulatory compliance, and high-quality service delivery.

The Claims Supervisor will:

• Supervise claims production activities and ensure efficient, accurate workflow

• Hire, coach, and performance manage team members

• Prioritize daily work, departmental initiatives, and special projects

• Support the Manager of Claims in driving overall department performance

• Serve as a subject matter resource and represent the department in meetings

• Lead special projects and respond to emergent operational issues

• Ensure compliance with state mandates, regulatory requirements, and internal policies

This position requires strong leadership skills, sound judgment, analytical thinking, and a solid understanding of claims operations to maintain operational excellence and support continued organizational growth.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both with our hybrid workplace model.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Demonstrates commitment and behaviors aligned with the philosophy, mission, values, and vision of Network Health.
• Applies organizational, regulatory, and credentialing principles, policies, and procedures to the claims production process. Assists the Manager of Claims Production and/or Manager of Claims Recovery with regulatory reporting and compliance audits, including Data Validation, Financial Audits, and CMS Program Audits.
• Monitors and tracks Service Level Agreements (SLAs) and Key Performance Indicators (KPIs), identifies patterns, and escalates issues to leadership as needed.
• Supervises assigned claims staff, including hiring, training, performance evaluations, salary recommendations, and managing discipline and termination processes. Collaborates with the Manager of Claims Production on hiring, salary decisions, discipline, and terminations. Provides performance feedback to improve the skills and performance of both claims and claims recovery staff.
• Coordinates staffing schedules to maintain optimal staffing levels. Establishes department turnaround times and production rates. Sets departmental priorities and develops efficient workflows to meet objectives. Ensures compliance with desk procedures and regulatory requirements.
• Prepares and analyzes daily, weekly, and monthly operational reports, distributing relevant data to appropriate departments. Works with the Manager of Claims Production to set claims-related goals and develop strategies to meet them.
• Maintains communication with other Network Health departments to assess and improve the effectiveness of the claims function, including standardizing and documenting policies and procedures, facilitating new policy implementation, and identifying opportunities for internal efficiency improvements.
• Recommends and oversees employee training for claims staff. Organizes and leads regular staff and department meetings.
• Performs claims-related tasks, such as processing high-dollar claims, monitoring suspended claims reports to ensure timely resolution, and serving as a liaison between the claims department and other departments. Documents results in QNXT, TMG FACETs, TMG Call, and QuickBase applications.
• Other duties as assigned.

Job Requirements:

• Associate Degree or equivalent experience required. Bachelor's degree preferred
• One year of experience in a leadership role, preferably in a health insurance industry
• At least two years of health insurance claims experience is required

Network Health is an Equal Opportunity Employer