Claims Supervisor

Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER

The Claims Supervisor performs claims related work in the area of: EPIC system maintenance of the Vendor and Provider Master Files; auditing of claims on a regular basis; assisting with the processing of all types of claims; problem solving involving difficult claims; running the weekly pay cycle when needed; assisting with running department reports and maintaining other master files, as needed.

The incumbent oversees daily operations of the claims processing team, including staffing, training, performance monitoring, scheduling, policy guidance, team communication, customer issue resolution, and participation in organizational meetings. The incumbent works under the general guidance and supervision of the Insurance Operations Manager.

GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well-being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid short-term disability, long-term disability, and life insurance. Additional benefits include a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more. Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW.

Job Specific Minimum Qualifications

1. High school graduate or equivalent required.
2. Minimum of two (2) years experience in claims resolution /processing or closely related work in an insurance or healthcare environment is required.
3. Knowledge of or ability to accurately apply claims processing techniques, procedures and practices in a timely manner is required.
4. Demonstrated leadership experience in an insurance or healthcare environment is highly desirable.
5. Ability to participate in the training of other staff is required.
6. Ability to ensure that the daily work of the department is completed.
7. Ability to communicate with courtesy and tact in dealing with others is required.
8. Ability to recognize, identify and report problems is required.
9. Ability to be flexible and be a team player is required.
10. Ability to concentrate and maintain accuracy in spite of frequent interruptions is required.
11. Ability to develop and maintain a working knowledge of claims adjudication rules, computer functions, usual and customary costs, discounts, rates, capitated payment arrangements, contract deadlines, provider changes, electronic data interchange (EDI) information and benefit plans is required.
12. Ability to develop and maintain a working knowledge of claims adjudication, COB and benefit rules, EPIC system functions and master file capabilities, vendor contracts, and fee schedules is required.
13. Knowledge of medical terminology preferred.
14. Knowledge or CPT -4 and ICD -9 coding is desirable.
15. Knowledge of and ability to use computers including billing system software, database, word processing, email, and calendar programs. Experience with EPIC systems is highly desirable.
16. Good organizational skills required. Must be detail oriented and work with a high degree of accuracy.
17. Excellent customer service skills, including verbal and written communication skills is required. Ability to build and maintain effective working relationships with internal and external customers.
18. Ability to type accurately required. Ability to use a keyboard extensively is required.
19. Ability to use a 10-key calculator accurately required.
20. Ability to maintain patient confidentiality required. Knowledge of HIPAA requirements.
21. Ability to handle and prioritize multiple tasks accurately and in a timely manner required.
22. Ability to work independently, with minimal supervision, under pressure, and with time restraints is required.
23. Ability to sit for extended periods of time required.
24. Ability to reach, bend and lift is required.

The incumbent knows and abides by all GHC-SCW organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.

Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being.

Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.

Our Values:

• We are a not-for-profit Cooperative
• We are member-centered
• We are equitable and inclusive
• We are quality-driven
• We are innovative
• We are community involved

We believe:

Healthcare is a human right.

In treating all people with dignity and respect.

There is strength in diversity.

Equity celebrates our humanity.

We are better together.

Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.