Provides operational support for activities associated with all phases of the claims process. Ensures accurate and timely payment of claims to meet or exceed customer service level agreements. Receive, sort, batch, scan and verify all incoming claims. Properly adjudicate claims based on knowledge of covered benefits, insurance and provider contracts. Identify and resolve issues around pended claims. Manage claims adjudication and case negotiation process as it relates to motor vehicle accidents (MVA) and worker's compensation (WC) cases. Coordinate benefits (COB) with other insurers. Determine plan liability as well as diversion and recovery activity for MVA, WC and COB claims.
Typically, the Supervisor level oversees the activities of assigned staff within a functional area with responsibility for staffing, quality and customer service. Directs staff to complete assignments using established guidelines, policies and procedures. Provides feedback on performance issues. Monitors costs and recommends cost-saving options to leadership. This level is expected to have full functional knowledge of area of responsibility and may spend a portion of time performing the duties typically assigned to their subordinates. The Supervisor will not be performing the same work as the associates he/she supervises more than 50% of their time. Associates who supervise and spend more than 50% of their time on individual contributor tasks, should be classified at the appropriate individual contributor level.
*Requires minimum of 3 to 5 years of related experience or equivalent combination of education and experience. Other typical working titles may include: ILR Supervisor, Claims Supervisor, Mailroom Supervisor.
SUPERVISORY RESPONSIBILITIES
Total Associates Supervised 23
Direct Supervision Yes Team Leader N/A
Indirect Supervision N/A Project Team N/A
Minimum Educational Requirements:
- *place 1st educational requirement*
- *place 2nd educational requirement*
- *place 3rd educational requirement*
- *place 4th educational requirement*
- *place 5th educational requirement*
- *place 6th educational requirement*
Minimum Certifications or Other Professional Credentials:
- *place 1st certification / professional credential*
- *place 2nd certification / professional credential*
- *place 3rd certification / professional credential*
- *place 4th certification / professional credential*
- *place 5th certification / professional credential*
- *place 6th certification / professional credential*
*place very important information here such as if relocation is offered; is extensive travel required; etc*
Perot Systems is committed to Equal Employment Opportunity. It is the policy of Perot Systems Corporation to encourage and support equal employment opportunity for all Associates and applicants for employment without regard to sex, race, color, ancestry, religious creed, national origin, pregnancy, physical disability, mental disability, medical condition, age, marital status, political affiliation, sexual orientation, disabled veteran or Vietnam era veteran status.