Supervisor, Claims Operations - NW region

Supervisor, Claims Operations - Must be based in the NW region

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Supervises data collection/interpretation by providing guidance and support to others on implementing required system configuration changes, monitoring and guiding others on inputting claims details into claims databases, and identifying and recommending resources to aid the maintenance and quality of data in KP systems. Ensures the team abides by protocols when collecting referral data, provides direction to others who verify referrals or authorizations, and oversees the submission of audit reports.

Ensures their team is knowledgeable of compliance protocols and provides clarification on relevant compliance standards, regulatory policies, laws, or accreditation standards. Directs and plans the work of teams for strategic projects, provides analysis support in response to process/system issues, recommends ways to improve operating efficiency, and implements performance metrics. Supervises member identification/support processes by directing the processing of insurance claims, assigning and providing guidance to team members to develop solutions to claims and benefits inquiries.

• Recommends developmental opportunities for others; builds collaborative, cross‑functional relationships. Solicits and acts on performance feedback; provides team members with feedback; and mentors and coaches to drive performance improvement. Pursues professional growth; provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Implements, adapts, and stays up to date with organizational change, challenges, feedback, best practices and processes.
  
  Fosters open dialogue, supports, mentors, engages, and motivates team members on collaboration. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope.
• Supervises and coordinates daily activities of designated work team or unit by monitoring the execution and completion of tactical action items and work assignments; ensures all policies and procedures are followed. Aligns team efforts and standards, and measures progress in achieving results; determines and carries out processes and methodologies; resolves escalated issues as appropriate. Develops work plans to meet business priorities and deadlines;
  
  coordinates, obtains and distributes resources. Removes obstacles that impact performance; identifies and recommends improvement opportunities; influences teams to execute in alignment with operational objectives.
• Supervises the payment of claims by: overseeing team performance on the review and to ensure that all expenditures are properly adjudicated and paid on time in accordance with contractual benefits; and providing guidance and oversight on the communication of claims information (e.g. pay decisions, referral matching) to adjudicators, vendors, and stakeholders on payment approval/denial and provides guidance on addressing escalated claims payment issues.
• Provides oversight for compliance by: ensuring their team is knowledgeable of policies and procedures which support compliance protocols; providing guidance to their team members to clarify relevant documentation, policies, and processes related to referrals, authorization processes, and utilization review; using thorough knowledge of claims processing practices to ensure relevant compliance standards, regulatory policies, laws, or accreditation standards are incorporated into training;
  
  and collecting and conducting data analysis and report development of claims activity for submission to appropriate regulatory bodies.
• Supervises data collection/interpretation by: providing guidance and support to others on implementing required system configuration changes, reviewing completed system configurations to ensure they are error‑free; monitoring or guiding others who are inputting, reviewing, or auditing claims data in claims databases across various regions; and aligning teams on methods…