Claims Supervisor - System Configuration

Johnston, IA (http://maps.google.com/maps?q=9000+Northpark+Drive+Johnston+IA+USA+50131)

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Job Type

Full-time

Description

Come Smile with Us!

Are you ready to lead with purpose? Delta Dental of Iowa is seeking aClaims Supervisor - System Configurationto lead the day-to-day operations of our commercial and government programs clinical claims processing team. In this role, you will monitor, maintain and maximize team performance; ensure service metrics are met; and deliver exceptional quality service to our customers. This is an opportunity to foster a high-performance culture with emphasis on continual process improvement and achieving or surpassing performance objectives for internal and external stakeholders.

Essential Functions and Principal Accountabilities:

• Lead staff and work processes to ensure individual goals of the staff, team, and department are met in support of corporate objectives. Address any performance issues regarding schedule adherence and expectations.

• Perform monthly staff quality reviews. Coach staff members and the team related to performance results, including but not limited to quality assurance results claim processing, and overall goals.

• Hire, train, develop, and lead a team of employees who are highly motivated and focused on timely and high-quality results for stakeholders.

• Provide continuous evaluation while performing quality assurance of department processes and procedures, identifying opportunities to reduce error trends and increase first pass accuracy rate.

• Seek to improve performance through automation, leading to improved operational outcomes and customer experiences.

• Track and monitor daily workload to ensure customers, stakeholders and internal operations expectations are met.

• Provide support in the proper implementation of claims processing regulatory and compliance requirements, balancing the requirements of commercial and government clients including performance guarantees. Monitor adherence to customer performance guarantees and develop and implement corrective actions as necessary.

• Participate in the claims policy processing matrix and CDT annual review.

• Establish and maintain effective working relationship with Provider Relations, Chief Dental Officer and the Government Programs team as it relates to claims activities. Ensure adherence to claims policy and processing standards and works jointly with Provider Relations on appeals.

• Participate in strategic initiatives and special projects for on time delivery and with high quality. May include assisting with requirements, perform testing, documentation, training.

• Communicate departmental information so that staff and department leadership remain informed of current issues, announcements, and changes to our processes or products.

• Assist in resolving claim problems and call escalations as needed.

• Create a team environment that generates innovation and empowerment by cross-training staff.

• Represent company in a highly energized, positive, professional, and effective manner.

• Establish and maintain a positive team working relationship with all co-workers and internal and external stakeholders.

• Recommend and actively participate in implementing process improvements.

• Adhere to processing standards related to quality, documentation, and turnaround time.

• Comply with the policy and procedures, including the DDPA standards as applicable.

• Maintain strict confidentiality; adherence to all HIPAA laws is always required.

• Dependability in attendance and punctuality required.

• Job requires confidentiality regarding information acquired in carrying out the job functions.

• Perform other duties as assigned.

Requirements

• Bachelor’s degree or three to five years applicable experience in claims processing.

• Previous supervisory and/or leadership experience managing to production and quality objectives.

• Knowledge of insurance reimbursement practices, i.e. processing claims, processing policies, deductibles, maximums, coordination of benefits (COB).

• Ability to develop and motivate staff to achieve departmental objectives and in a positive, team environment.

• Excellent written and verbal communication skills.

• Demonstrated ability to interact with internal and external stakeholders in an effective and positive manner.

• Advanced computer skills, including Microsoft Excel and Word, as well as other software as required.

• Ability to analyze & present information and make independent decisions.

• Ability to work independently and as part of a team to complete assigned tasks and achieve goals.

• Demonstrated ability to prioritize, organize and function effectively with multiple tasks/assignments.

• Ability to meet with stakeholders and respond to their questions and concerns in a professional manner.

• Competency in advanced math skills.

• Knowledge of dental benefits preferred.

Delta Dental of Iowa is an Affirmative Action and Equal Opportunity Employer committed to providing equal employment opportunity for all persons without unlawful regard of race, color, religion, sex, sexual orientation, gender identity, age, national origin, individuals with disabilities, protected veteran status, or any other legally protected basis.

EEO/AA Poster (https://www.dol.gov/sites/dolgov/files/OFCCP/regs/compliance/posters/pdf/22-088_EEOC_KnowYourRights-ScreenRdr.pdf)