Medical Claim Supervisor

Job Summary:

We are looking for a dedicated and experienced Medical Claims Supervisor to manage and oversee the daily operations of the medical claims team for one of our esteemed clients, an insurance company. The successful candidate will be responsible for supervising the claims processing workflow, ensuring that all claims are managed efficiently, accurately, and in accordance with company policies. This role also involves providing guidance to the claims team, reviewing complex claims, and collaborating with other departments to ensure smooth operations and high-quality service.

Key Responsibilities:

• Supervise the daily operations of the medical claims team, ensuring the timely and accurate processing of medical claims.
• Review and assess medical claims to ensure compliance with company policies and medical guidelines.
• Provide coaching, training, and support to the claims team to improve performance, accuracy, and efficiency.
• Handle and resolve escalated claims, providing solutions for complex or disputed cases.
• Collaborate with internal departments, including underwriting and reinsurance, to resolve coverage issues for non-standard medical procedures and surgeries.
• Ensure that all claims are processed in line with established turnaround times (TAT) and industry standards.
• Monitor and track claim trends, identifying areas for process improvement and cost containment measures.
• Review and summarize insurance policy terms and ensure claims are processed in accordance with policy conditions.
• Conduct regular performance evaluations for claims team members, offering feedback and setting goals for professional development.
• Maintain an up-to-date knowledge of industry regulations and best practices, ensuring the team adheres to all relevant guidelines and legal requirements.

Qualifications:

• Bachelor's degree in Medicine, Healthcare, Medical, a Doctor's degree or a related field.
• Minimum of 3 years of experience in medical claims management or a similar role, with at least 1 year in a supervisory capacity.
• Strong understanding of medical claims processing, insurance policies, and medical terminology.
• Excellent leadership, coaching, and mentoring skills.
• Strong problem-solving and decision-making abilities, particularly in complex claims situations.
• Exceptional organizational and time-management skills, with the ability to manage multiple tasks simultaneously.
• Proficiency in using claims management systems and other relevant software.
• Strong communication skills, with the ability to interact effectively with internal teams and clients.