Job Information
Blue Cross and Blue Shield of Louisiana Supervisor, Claims Operations in United States
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSE
Oversees the daily operations of the unit for assigned staff in the unit. Serves as a leader and back-up for assigned staff in the unit. Directs and coordinates workload to achieve performance goals and ensures complex cases that require special expertise in the unit are resolved in a timely manner. Complies with all laws and regulations associated with duties and responsibilities.
NATURE AND SCOPE
Manages People
This role directly manages workers
This role directly manages these jobs: CLAIMS PROCESSOR I;CLAIMS PROCESSOR II;CLAIMS PROCESSOR III;CLAIMS SPECIALIST I;CLAIMS SPECIALIST II;CLAIMS SPECIALIST III;STOP LOSS SPECIALIST
This role reports to this job: MANAGER, CLAIMS OPERATIONS
Necessary Contacts: In order to effectively fulfill this position, the Supervisor, Claims Operations must be in contact with:
Various internal departments and staff including, but not limited to Compliance, Payment Integrity, Health Care Policy, Care Management, Actuarial, Sales, Marketing, Provider Services, Legal, Audit, IT, Project Management Office, other Benefit Operations Management and staff, Administrative Services, and District Offices.
Various external entities including, but not limited to Vendors, Providers, Members, Attorneys, Groups, Commissioner of Insurance, CMS, other insurance companies, BCBSA and other Plans.
QUALIFICATIONS
Education
High School Diploma or equivalent is required
Bachelor's is preferred
Work Experience
3 years of operational experience is required
1 year of demonstrated leadership is required
Experience can run concurrently
Claims experience is preferred
Skills and Abilities
Must demonstrate verbal communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
Must have strong organizational and analytical abilities and effective interpersonal skills. Must be able to recognize inconsistencies and gaps in business processes and take appropriate actions.
Must be able to prioritize multiple responsibilities, make decisions, find solutions and work independently in order to meet aggressive deadlines, and adapt to a fast-paced, changing environment.
Must be able to coach and develop front line staff.
Able to cohesively work in team environment to ensure efficient and effective completion of all tasks for assigned groups.
Must have working knowledge of relevant software (e.g., MS Word, Excel, Outlook, etc.) and related software as well as other corporate programs and applications and the ability to learn new systems.
The applicant selected must complete the recommended BCBSALA Leadership Development Program within 6 months of start date in the supervisor position.
Must have thorough insurance knowledge to apply company policies and procedures, company guidelines, state and federal laws and mandates is current and accurate.
Licenses and Certifications
- None Required
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Administers all HR functions, including but not limited to, hiring, terminating, conducting performance reviews, setting performance standards, approving work schedules, assigning and directing workload, training and developing staff, coaching, etc. to ensure team goals are met.
Cultivate a strong team environment that fosters positive attitudes, collaboration, and high performance.
Serves as the subject matter expert of assigned staff and maintains thorough knowledge of required lines of business, changes to recent laws and regulations, HCPCS coding, ICD-10 codes, medical terminology, computer systems and claims policies and procedures to ensure consistency in delivery of excellent customer service.
Monitors, tracks, and distributes inventory daily, allocating resources when appropriate to ensure performance and production standards are being met in accordance with relevant policies, procedures and/or departmental guidelines.
Reviews, tracks and provides additional training with support staff, to identify deficiencies, implement corrections, and eliminate errors and ensure that performance standards are being complied with in accordance with relevant policies, procedures and/or departmental guidelines.
Identifies and responds to system problems that impact quality and/or productivity by working with appropriate personnel for corrections and documenting findings, continually educating staff on system issues, understanding changes to existing benefits/plans, testing, understanding and complying with company changes, etc. to ensure prompt and accurate resolutions.
Reviews all MTM and Quality Management audits for Claims Control and responds and/or counsels accordingly to maintain quality and compliance standards.
Monitors the aging process on all inventory to ensure compliance with, MTM, and other BCBSA policies and Corporate guidelines.
Manages staff turnover, schedule adherence, quality performance and employee, member and/or provider satisfaction based on established metrics to help ensure team, departmental, divisional and/or company goals are met.
Frequent contact with Attorneys and other Insurance Companies negotiating and settling third party liability cases and seeking reimbursement of monies owed to Blue Cross Blue Shield of LA. Additional contact with various other external entities including, but not limited to, Providers, Members, Groups, Commissioner of Insurance, and other Plans. Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Administration Management and staff, Membership and Billing, Administrative Services, and District Offices.
Monitors inventory reports/systems to find resolutions to departmental functions /services and develop preventive measures to ensure maximum efficiency of resources.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
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An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance