Claims Supervisor

South San Francisco, CA 94080

Posted: 02/22/2019 Employment Type: Direct Hire Industry: Health Care Job Number: 15070

Bayside  Solutions is seeking a Claims Supervisor  to be a part of our partner’ s team in the South San Francisco. This is an opportunity to provide access to a stable and comprehensive network of providers, and a benefits program that promotes preventive care with staff devoted to ensuring Medi-Cal patients receive high quality, coordinated health care.

Our Company Bio:  Bayside Solutions was founded in 2001, Bayside was recognized as one of the fastest growing professional staffing companies in Northern California. The numbers tell the story: We have close to a 100% client retention rate, 700% growth in four plus years and over 95% repeat business. Our dedication to building partnership relationships with both our clients and our recruits is the key to our phenomenal success.

You can find additional information on our company website at www.baysidesolutions.com.

Claims Supervisor 

Job Benefits:
  • An opportunity to join a local non-profit health care plan that offers health coverage and a provider network to San Mateo County' s under-insured population.
  • Company that currently serve more than 145, 000 County Residents
  • Competitive compensation commensurate with experience
  • Excellent benefits package offered, including HPSM paid premiums for employee’ s coverage in the medical HMO plan and majority of PPO medical cost.

Summary of Responsibilities:
  • Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures and productivity standards. 
  • Complete performance evaluations in a timely manner.
  • Ensure departmental goals are met; develop strategies and schedules for meeting stated goals.
  • Assist claims manager develop policies and procedures, job aids, reference materials and/or desk procedures for all unit workflows.
  • Monitor and review the examiners workload and productivity; provide direction and backup as needed.
  • Continuously monitor and evaluate unit performance, taking steps to improve the efficiency and quality of unit operations.
  • Recommend opportunities for improvement identified through trend analysis.
  • Implement necessary policy and regulatory changes.
  • Communicate newly-identified and potential issues to claims manager or other departments as necessary.
  • Maintain knowledge of industry trends, bet practices and regulatory requirements.
  • Facilitate and document meetings.
  • Perform other duties as assigned.

Required Qualifications:
  • Bachelor’ s degree in a related field.
  • Five (5) years of claims management experience with at least two (2) years in a supervisory role. 
  • Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Medi-cal and Medicare program guidelines CPT, HCPCS, revenue and ICD-10 coding.
  • Ability to: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Analyze and problem solve, making good decisions. Adapt to changes in requirements/priorities for daily and specialized tasks. Collaborate with multiple parties to solve problems and solve problems independently.  Provide feedback in a constructive and growth-oriented manner.

 

Ethan Christenson
Scientific Recruiter

If you are looking for career growth or new opportunities you have come to the right place! Here at Bayside solutions we specialize in relationship based recruiting, we are focused and determined to take your career in the direction you want it to go. I would love to talk to you about your career objectives, sports, traveling, or anything else that interests you. I look forward to getting to know you and where you want to go!
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