About this role
At RAM Health, our mission is to simplify the complexities of healthcare administration through innovative, technology-driven solutions. With a focus on changing the industry one plan at a time, we drive continuous innovation to help government-sponsored health plans improve performance and quality while reducing costs.
RAM Health - Health plan administration, simplified.
The Claims Supervisor plays a critical role in managing the day-to-day operations of the Claims Department. This position involves supervising a team of Claims Specialists, ensuring the timely and accurate processing of healthcare claims, and managing both client relationships and internal team dynamics. The Claims Supervisor will focus primarily on workforce management, including training and coaching team members, addressing escalated claims issues, and representing the department in client interactions. This role requires a strong blend of leadership, operational management, and client service skills.
Responsibilities
• Have a comprehensive understanding of the end-to-end claims intake processes, adjudication and payment process, Encounter submission and error resolution.
• Have the ability to manage the workload and staffing in a holistic manner to ensure compliance with regulatory and contractual requirements.
• Act as a liaison and escalation point for clients.
• Maximize use of the RAM processing platform and products to drive automated and efficient manual outcomes
• Develop department policies and procedures, workflows, handoff processes, etc.
• Prepare formal training approach, timelines, etc. to onboard staff.
• Assess and maximize workflow capabilities.
• Coordinate with IT/Ops Support to ensure UAT plans, scenarios and cases align with operational processes and expected results.
• Assess reporting needs for responsible functions and determine how best to operationalize a metric drive approach to managing the department and client outcomes.
Role Workforce Management and Supervision (60%): • Oversee the daily activities of Claims Specialists, ensuring efficient and accurate processing of claims. • Provide ongoing training and support to team members, fostering a culture of high performance and continuous improvement. • Evaluate team performance regularly, offering feedback and coaching to enhance productivity and quality of work.
Escalation and Issue Resolution (30%): • Act as the primary point of contact for escalated claims issues, applying expert judgment and problem-solving skills to resolve complex cases. • Develop and implement strategies to reduce the frequency and severity of escalations. • Work closely with the Claims Manager to improve processes and policies based on trends in claim issues.
Client Interaction and Meetings (10%): • Engage with clients during regular meetings to discuss service performance, resolve issues, and gather feedback to improve service delivery. • Prepare detailed reports and presentations for clients to highlight key performance metrics and ongoing initiatives. • Serve as a liaison between the claims processing team and clients, ensuring clear and effective communication.
Industry Experience
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• 7-10 years in healthcare industry experience working in the payer segment in Medicare Advantage, Managed Medicaid, or working with an industry competitor.
• Experience in BPaaS environment is a plus.
Skills & Knowledge
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• Candidate should have experience working in a production environment and the ability to meet performance standards.
• Attention to detail and the ability to apply documented procedures to achieve desired outcomes are also required.
• MS Word and MS Excel, good interpersonal skills, written and oral communication abilities a must.
This position offers an excellent benefit package that includes medical, dental, vision, 401(k) with match, life insurance, LTD, 5 weeks' vacation, and paid holidays $55K-$60K