Operations Supervisor

Job Description

Job Description

Description:

SUMMARY

The Operations Supervisor oversees the review staff, ensuring adherence to the company's policies and guidelines. This role is responsible for ensuring that claim settlements are complete and accurate, based on the terms of the clients' Trust contracts with the company. The Operations Supervisor is well-versed in the concepts, practices, and procedures of claims management, and leverages experience and judgment to plan and achieve goals. The role involves performing a variety of complex tasks, leading and directing the work of others, managing the claims staff, and reporting to management.

PRIMARY RESPONSIBILITIES

1. Supervise the review staff in accordance with company policies and procedures, overseeing their professional development.

2. Conduct performance evaluations for review staff members and ensure reviewers meet production and quality goals.

3. Manage work schedules, including work assignments, training, vacations, breaks, overtime, backup for absentees, and rotations based on management’s direction.

4. Coordinate with Claims Services Representatives to respond to inquiries from claimant attorneys.

5. Coordinate with Management to ensure appropriate staffing levels.

6. Coordinate with other Supervisors and members of the Operations and Quality teams to ensure consistency of information and Identify opportunities for training of review staff.

7. Coordinate with IT and other members of Operations to assist users and resolve technical problems.

8. Review and approve payroll/attendance reports for the review staff.

9. Prepare funding request reports for assigned trusts

10. Participate in audits (Financial, SOC, and others) as directed.

11. Review invoice reports for assigned trusts.

12. Assist with quarterly board packages and attend Trust and Trust Council meetings as needed.

13. Resolve QA and QC disputes.

14. Operate within established Claims Review Guidelines.

15. Maintain working knowledge of all current review procedures as well as updates in the claims review process documentation.

16. Assist with system improvements: system testing, user testing, design, specs etc.

17. Other duties/tasks as assigned.

KNOWLEDGE AND SKILL REQUIREMENTS/COMPETENCIES

· Demonstrated relevant work experience with an obtained level of Claims Reviewer III or higher.

· Strong working knowledge of trust requirements with the ability to learn additional trusts quickly and accurately.

· Knowledge of the claims review processes, procedures, and computer system.

· Computer literacy: Windows, Word, and Excel.

· Ability to prioritize.

· Adaptability to changing policies, procedures, and systems.

· Effective communication and interpersonal skills.

· Strong managerial/leadership skills.

· Excellent problem-solving skills in Verus applications and ability to collaborate with IT to improve them.

WORKING CONDITIONS

Normal business office conditions. Working for prolonged periods of time at a computer screen. Consists of in-office and remote work.

Medical, Vision, Dental, Paid Time Off, Retirement, Life