[Hiring] Claims Supervisor @Versant Health

Role Description

The Claims Supervisor is responsible for the daily oversight and administration of Claims Department operations, ensuring timely, accurate, and compliant claims processing. This role provides leadership, coaching, and development to Claims Examiners and support staff while monitoring productivity, quality, service level performance, and workflow management. The Claims Supervisor serves as a subject matter expert (SME) and collaborates with cross-functional partners to support operational excellence, process improvements, and achievement of departmental goals.

• Provide day-to-day leadership and supervision of the Claims team, including coaching, mentoring, training, and performance management.
• Monitor and evaluate team productivity, quality, accuracy, turnaround times, and adherence to established service level agreements (SLAs).
• Establish clear performance expectations and provide ongoing feedback, development plans, and corrective action when necessary.
• Support employee engagement through recognition, motivation, career development, and team-building initiatives.
• Facilitate onboarding and training of new team members and support ongoing staff development.
• Prepare, analyze, and communicate daily, weekly, and monthly claims performance reports and operational metrics.
• Monitor departmental workflows and inventory levels, adjusting assignments and priorities as needed to ensure timely completion of work.
• Collaborate with internal business partners including Configuration, Quality Assurance, Eligibility, Customer Service, Provider Relations, and Information Technology to resolve claims processing issues and improve operational efficiency.
• Serve as a subject matter expert for claims adjudication policies, procedures, payment methodologies, and claims processing systems.
• Investigate and resolve complex claims issues, payment discrepancies, provider inquiries, and system-related adjudication concerns.
• Support claims processing activities and work inventories during periods of increased volume or operational need.
• Participate in user acceptance testing (UAT), system enhancements, and implementation activities related to claims operations.
• Manage assigned operational processes, including reject and denial workflows, correspondence tracking, check processing activities, and inventory management.
• Identify trends, root causes, and opportunities for operational improvements through data analysis and workflow reviews.
• Partner with management to develop and implement process improvements, quality initiatives, and compliance standards.
• Assist with recruitment activities, including candidate interviews, selection recommendations, and onboarding support.
• Ensure compliance with company policies, regulatory requirements, and departmental procedures.
• Perform other duties and special projects as assigned.

Qualifications

• Bachelor's Degree in business administration, healthcare administration, or related field required.
• 5+ years of experience in the managed care industry with a working knowledge of claims processing, claim adjustments, refunds, self-funded accounts, eligibility, and customer services required.
• Strong verbal and written communication skills.
• Minimum 2-4 years of leadership, supervisory, or team lead experience.
• Demonstrated ability to analyze operational data and performance metrics.
• Proficiency in Microsoft Office Suite, particularly Excel, Word, and Power BI or reporting tools.

Requirements

• All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI).
• Associates may have access to covered information, cardholder data, or other confidential customer information which must be protected at all times.
• Associates must adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

Benefits

• Medical, dental, and paid vision coverage.
• Paid time off and company holidays.
• Retirement savings with employer contribution.
• Employee wellness resources.
• Professional development opportunities.
• Flexible work arrangements.
• Employee assistance programs.