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Supervisor, Adjustments-Service

Claims Adjustment

Location: 441 9Th Avenue

SAS CA

Essential Duties:

Supervise Adjustment units staff facilitating workflow for the daily processing of medical claims and issues
Oversee and monitor the workflow of Claims Approves responsible for resolving inquiries from providers and subscribers
Provide training and direction to staff, review work performance
Perform pre-payment and post-payment audits of inquires
Perform administrative functions including preparation of daily, weekly and monthly production reports, audits and approves letters
Maintain attendance reports and weekly payroll
Analyze inquiry types to determine trends and recommends changes in methods, procedures, systems and/or policies to improve upon the operation of the section

Knowledge Skills & Abilities:

Effective written and verbal communication skills
Demonstrated ability to build successful working relationships (internally and externally)
Supervisory and business administrative experience/knowledge
Ability to prioritize, follow-up and follow-through with timeliness and accuracy while remaining organized with a keen sense of detail

Qualifications:

College degree preferred
Minimum one year claims processing experience for Medical claims preferred
Minimum of two years related supervisory experience
Strong knowledge of Medical Claims processing , procedures and systems including entry, exceptions and the manual system
Extensive knowledge of contracts and medical terminology
Knowledge of a customer service department preferred