Claims Supervisor

Position provides direct management of non exempt associates and/or assists in activities for the business function (or multiple functions) within Operations, internal and/or external people management, Root Cause Analysis, Trending, and Process Improvement all can be key aspects of this position. Assignments are broad in nature.

Department: Ops, Claims

Report To: Mgr, Claims

Location: Phoenix, AZ 85016



Essential Functions:

  • Manages and monitors key performance metrics and implements improvement plans either to the individual or at an aggregate level.
  • Handles all direct employee personnel issues and processes (where applicable), including performance management, appraisal processes, development planning, and career pathing.
  • Supervises non exempt direct reports assigning workload, monitoring quality and associate coaching.
  • Serves as liaison between departments when it becomes necessary due to member or workflow issues.
  • Develops, recommends, and implements process improvements to improve efficiencies and services provided.
  • Performs root cause and trending analysis on data error reports from operation systems and business units.
  • Updates and creates resources on Well Care link applicable to the call center, such as timely announcements, step actions, reference call tools, FAQs etc.
  • Ensures WellCare link is update to with the appropriate materials.
  • Trains associates on new processes and refresher training.
  • Facilitate and participate in meetings with other departments and line of business as needed.
  • Act in a liaison capacity for the Mgr/ Sr Mgr representing operations with other areas and business units.
  • Responsible for reviewing, updating, and creating training materials for business.
  • Ensures all business processes are compliant with state and federal guidelines
  • Demonstrates desired behaviors by exceeding others expectations and leads by example
  • Completes gap analysis on training for the business.
  • Other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED or equivalent
    • Preferred A Bachelor's Degree in a related field
    Candidate Experience:
    • Required 4 years of experience in a related field based on operational area, i.e., customer service, claims, call center, or a high transactional environment,accounts receivable application, etc.
    • Required Other Experience supervising or leading others
    Candidate Skills:
    • Intermediate Demonstrated analytical skills
    • Intermediate Demonstrated written communication skills
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Ability to communicate and make recommendations to upper management
    • Intermediate Other In-Depth knowledge of Health Insurance
    • Intermediate Other Strong understanding of managed care and its place in the health care industry
    • Intermediate Other Understanding of interdependencies on other business units such as Health Services, Provider Relations, Sales, Vendors, Claims
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Word
      • Required Intermediate Microsoft Outlook
      • Required Intermediate Microsoft Excel
      Languages:

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.