Claims Review Supervisor​/Expert

position summary

claims review supervisor/expert position is responsible for supervising the program eligibility specialists in the ui benefits hotline to guarantee adequate coverage on the hotline at all times. In addition, the claims review supervisor/expert will review calls taken by their staff to check for accuracy and customer service expectations. This requires a high level of accountability in ensuring the work their staff is doing is in compliance with state and federal regulations and agency policies.

success in this position depends on strong communication skills to effectively engage with their staff with a focus on efficiency in protecting the integrity of the trust fund. This position requires extensive ui knowledge.

this staff may also have to communicate with other ui units as well as employers, legislative staff, and staff from the governor's office.

one (1) year experience working with the unemployment insurance program and intensive knowledge of ui system and program processes and terminology. Previous experience in supervising staff. Additionally, experience conducting business via telephone and/or email is a must.

• knowledge of computers, office equipment, and imaging programs
• ability to develop, recommend, interpret, and apply policies and procedures.
• must have good customer service skills - verbal and written.
• good communication skills.
• good research skills.
• good critical thinking skills.

• provide support and supervision of ui benefits hotline program eligibility specialists one-on-one or through the ui benefits hotline teams chat.
• monitor ui benefits hotline to ensure adequate coverage of the hotline.
• review ui benefits hotline statistics daily to discover calls lasting over 20 minutes, long hold times, or any anomaly in the hotline calls to determine if there is any training or procedure changes required.
• provide any specific ui benefits hotline analytics listed in the hotline statistics reports to the commerce program supervisor/expert or ui administration per request.
• answer questions from program eligibility specialists, claimants, or employers regarding ui. This requires a basic knowledge of ui processes and procedures and a level of critical thinking to apply state or federal law.
• responds to inquiries and processes requests from other adws ui units including ui
• intake and support, ui claims processing, ui correspondence, automated adjudication systems (aas), benefit accuracy measurement (bam), contributions, and other units regarding individual claims or issues found.
• listen to program eligibility specialists calls for quality purposes.
• research claims to detect problems and provide feedback on issues detected.
• performs other duties as defined and assigned by ui administration.

job series: program operations – claims review

classification: claims review supervisor / expert

class code: pcr
03p

pay grade: sgs
06

salary range: $52,137 – $77,163

the claims review supervisor / expert is a senior‑level professional responsible for overseeing the evaluation and processing of complex insurance claims. Leveraging their in‑depth knowledge and extensive experience, they ensure claims are handled with accuracy, efficiency, and in compliance with pre‑determined agency policies and legal regulations. This role requires advanced analytical capabilities to assess high‑value or intricate claims, mentor junior team members, and drive strategic improvements in claims management processes.

The claims review supervisor / expert is pivotal in maintaining organizational integrity, reducing risk, and enhancing customer trust.

the assignment of supervisory duties is determined by the hiring agency's operational needs. Non‑supervisory roles will serve as senior technical experts.

conduct comprehensive reviews of complex, high‑value, or specialized claims to determine eligibility and validity.

provide guidance and resolution for escalated claims that require expert analysis and decision‑making.

collaborate with…