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Service Operations Supervisor, Healthcare Claims Department
Service Operations Supervisor, Healthcare Claims DepartmentHealth Advocate • Lancaster, CA, US
Service Operations Supervisor, Healthcare Claims Department

Service Operations Supervisor, Healthcare Claims Department

Health Advocate • Lancaster, CA, US
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Health Advocate

Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are supportive and friendly. Employees have room to grow, and many of Health Advocate's supervisors are promoted from within the company. Join our award winning team!

Responsible for overseeing the daily tasks and workflow of assigned team of associates / specialists by providing direction and structure and aiding to answer questions using knowledge of services and benefits to help guide employees and perform necessary on the job training.

Job Responsibilities :

  • Responsible for the administrative functions and supervision of an operations unit. This includes backlog and quality management for a team of Operations / Customer Service associates
  • Provide organization, direction and staffing for all assigned service calls and case load assignments to ensure all calls are answered in accordance with Health Advocate's policies and procedures.
  • Monitor calls and audit case files daily to ensure the proper target resolution is identified and that, if possible, the case is closed at or near the target resolution.
  • Ensure assigned staff members meet or exceed the standards, results, and responsibilities of their respective positions.
  • Coach, mentor, and evaluate the performance of an assigned team.
  • Assist in the selection, counseling, and discipline of all staff on the team.
  • Provide oversight and direction to staff for assigned cases.
  • Responsible for problem-solving issues and coordinating efforts with internal departments and subject matter experts.
  • Provide healthcare benefit and claims consultation and support when appropriate to all internal departments.
  • Routinely evaluate and monitor service calls and case management procedures to recommend any necessary changes to the Operations Manager.

Team Interfaces / Customer Service - Establish and maintain a professional relationship with internal / external customers, team members and department contacts

  • Cooperate with team members to meet goals or to complete tasks
  • Provide quality customer service that exceeds customer expectations and improves level of service being provided
  • Treat all internal / external customers, team members, and department contacts with dignity / respect
  • Escalate to supervisor any situation outside the employee's control that could adversely impact the services being provided
  • Mental and Physical Requirements

  • This position will be exposed mainly to an indoor office environment and will be expected to work near or around computers, telephones, and printers
  • The nature of the work in this position is sedentary and the incumbent will be sitting most of the time.
  • Essential physical functions of the job include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software / hardware continuously throughout the work day
  • Essential mental functions of this position include concentrating on tasks, reading information, and verbal / written communication to others continuously throughout the work day
  • Related Duties as Assigned

  • The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties, and responsibilities required of job incumbents
  • Consequently, job incumbents may be asked to perform other duties as required
  • Also note, that reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above
  • Please contact your local Employee Relations representative to request a review of any such accommodations
  • Minimum Qualifications

  • Call center experience preferred
  • Management or supervisory experience in healthcare benefits or claims processing preferred
  • Strong leadership skills and the ability to build effective teams
  • Effective communication skills to interact with members, physicians, and insurance carrier representatives, with an emphasis on ability to communicate both verbally and in writing
  • Assertive, self-confident, and resilient
  • Basic computer skills
  • Ability to search and identify resources through the internet
  • Demonstrated ability to communicate concepts, strategies and plans in terminology understood by business professionals
  • Education

  • Bachelor's Degree or applicable work experience
  • Other

  • Basic knowledge of MS Word and Excel required
  • Must score acceptably on job related testing
  • Ability to pass standardized interview
  • Based on assignment may need to be bilingual in English, Spanish, etc.
  • Knowledge of the following is preferred :
  • COBRA
  • Medicare A, B, MediGap, Supplement plans, Medicare Advantage, Medicare Part D plans
  • High deductible health plans including Health Reimbursement Accounts (HRAs) and Health Saving Accounts (HSAs)
  • Flex Spending Accounts (FSA), including limited FSAs
  • Coordination of benefits and which plan is primary simple cases (commercial plans, Medicare plans)
  • Summary Plan Documents (SPDs) and Certificates of Coverage (COCs)
  • Government programs, resources and legislation and mandates including but not limited to Affordable Care Act, FMLA, Medicaid, CHIP
  • Group Health Plans (fully insured and self-insured)
  • Pharmacy benefits including injectable medications
  • Individual Health Plans and Marketplace / Exchanges plans
  • A successful incumbent in the job will be able to demonstrate the following skills and abilities :

  • Strong communication skills and phone etiquette
  • Ability to explain complex issues to members
  • Highly effective listening skills
  • Strong problems solving / issue resolution skills
  • Excellent customer service and customer resolution skills
  • Strong Organizational and administrative skills
  • Ability to work in a team environment
  • Why Health Advocate?

    At Health Advocate, we don't just resolve claimswe build trust and provide peace of mind. Here's what you'll gain by joining us :

  • Purpose-Driven Work : Be a key player in simplifying healthcare for members and making a real difference in their lives.
  • Tools for Success : Access advanced systems, comprehensive training, and the support of a collaborative team.
  • Competitive Pay : Annual salary starting at $55,000
  • Comprehensive Benefits : Enjoy competitive pay, robust medical, dental, and vision coverage, 401(k) with company match, PTO, and more.
  • A Culture of Care : Join a team that values empathy, innovation, and teamwork.
  • Your Next Move

    Ready to transform challenges into resolutions and make healthcare easier for those we serve? Apply today and take the first step toward a rewarding career with Health Advocate!

    Company Overview

    Health Advocate is the nation's leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need.

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