Claims Supervisor --------------------------------------------------------------- This position is responsible for supervising the day-to-day operations of the Claims Examiners within the Claims Department. The position provides staff with an ongoing understanding of the strategic and operational direction of the Claims Department. The position also processes high-dollar and complicated claims. Estimated Hiring Range: $72,765.00 - $88,935.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Coordinate and supervise the day-to-day operations of a claims team. Maintain and enhance production statistics including turnaround time, claims resolution of pending claim edits and adjudication of claims. Perform on-going analysis of data and information to identify opportunities to improve operational efficiency in claims processing and payment integrity. Perform effective analysis of claims reports and report those findings to claims management. Develop effective policies, procedures, objectives, and staff monitoring practices to ensure the department consistently achieves CareOregon’s claims service standards. Ensure claims team effectively collaborates with other CareOregon departments and our business partners. Act as a resource to Claims Examiners, Customer Service, and other departments. Keep abreast of changes and advancements in the claims processing and service arena. Collaborate with the Organizational Development Specialist, Claims Auditors, OPEX staff and Claims Trainers to develop and implement training programs for Claims Examiners and revise/update them as needed. Create and update documentation and resource materials as needed. Support vendor partnerships related to claim payment integrity activities. Employee Supervision Supervise team and recommend team direction and goals in alignment with the organizational mission, vision, and values. Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens. Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations. Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff. Train, supervise, motivate, and coach employees; provide support toward employee development. Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making. Ensure team adheres to department and organizational standards, policies, and procedures. Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action). Perform supervisory tasks in collaboration with Human Resources as needed. Experience and/or Education Required Minimum 4 years’ experience in claims Preferred skills: Experience working for a health insurance carrier/health plan and/or with the Oregon Health Plan Minimum 1 year experience in a supervisory or lead position or completion of CareOregon’s Aspiring Leaders Program; lead roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks Experience with Claims Supervision. Experience leading team of 4+ members. Knowledge, Skills and Abilities Required Knowledge Knowledge of Oregon Administrative Rules (OARs) related to claims processing, customer service and provider billing Knowledge of principles of organizational change and ability to act as a change agent Knowledge of the basic concepts of Managed Care Skills and Abilities Ability to effectively supervise diverse workforce, develop work plans, and ensure appropriate level of claims adjudication service Ability to mentor individual growth Excellent interpersonal skills Ability to effectively use claims processing systems and reports to manage department and individual performance Excellent customer service skills Excellent data analysis skills Basic mathematical skills Ability to effectively use Microsoft Outlook, Word, and Excel Ability to manage multiple tasks, complex projects and to delegate appropriately Excellent reading comprehension, oral and written communication skills Excellent problem-solving and decision-making skills Ability to work well under pressure in a complex and rapidly changing environment Skill in negotiation and ability to build consensus Ability to support and comply with organizational policies, procedures, and guidelines Ability to proactively identify ways to improve department quality and productivity and member satisfaction Ability to provide leadership to groups of people, vendor partnerships and in the implementation of projects Ability to be a positive and influential role model Ability to participate fully and constructively in department/organizational meetings and department/organizational decisions Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization. CareOregon is a nonprofit, mission-driven health plan, focused on providing care to low-income Oregonians. The CareOregon family includes Columbia Pacific CCO, Jackson Care Connect, Housecall Providers and our work as part of Health Share of Oregon. We also support recruitment for The Collaborative. Our mission is to inspire and partner to create quality and equity in individual and community health. Our vision is healthy communities for all individuals, regardless of income or social factors. Making Healthcare Work for Absolutely Everyone. Let's connect! Add your resume to our Talent Community to stay up to date with relevant career opportunities. Learn more about our benefits and joining CareOregon Click here for more information about jobs at Housecall Providers, part of the CareOregon family. We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status. Veterans CareOregon greatly encourages military veterans to apply. CareOregon is a major sponsor of the annual Portland Veterans Stand Down and hiring fair. Ranked #8 in the Health Care Category. Read more about the culture at CareOregon