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Supervisor, Claims/Trainer

Amalgamated Life Insurance White Plains Full-Time
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  • Oversees the administration of the assigned claims processing unit, including all functions and processes required to process medical, hospital, vision, dental and other claim types.
  • Performs personnel and job supervisory duties required to ensure that staff is meeting performance goals; conducts annual performance reviews; confirms production incentive; monitors employee attendance and lateness.
  • Monitors individual analyst production and quality providing feedback, support, and instruction to assist staff with meeting goals.
  • Manages claims inventory via Workflow with a goal of meeting required JAA and DOL turnaround time requirements.
  • Provides daily guidance and technical instruction to the claims staff, ensuring that claims are handled timely and appropriately.
  • Identifies training needs and conduct training for all Claims Personnel as necessary, including new hire classes.
  • Works with quality assurance department to provide feedback and corrective action on claims quality.
  • Must possess a working knowledge of all plans for which he/she is responsible and keeps up to date on any benefit plan and procedural changes that must be communicated to staff.
  • Oversees the claims correspondence ensuring handling within DOL timeframes; prepares responses if needed.
  • Interfaces with AMM on medical claim referrals and any pre-certification issues.
  • Consults with appropriate personnel through-out the company to obtain information required to resolve and process claims.
  • Maintains knowledge of eligibility requirements and understands the complexities of the system interfaces.
  • Monitors and oversees the correct handling of high dollar claims ensuring timeliness of handling; reviews, examines, and directs processing of unusual or difficult claims
  • Oversees the review, distribution, and response to Customer Service and service/account rep referrals/ inquires.
  • Handles various assignments or projects, as needed.
  • Analyze benefit documentation for new plans and existing plan benefits changes to ensure all documentation is accurate and current.
  • Engage in learning any new systems, functions or new claims technology, document and conduct training classes.
  • Assist with new hire implementation as necessary.
  • Assist in maintaining the Claims training manual and must stay abreast of all Federal and state laws affecting Claims payment.
  • Escalates any and all claims issues that is adverse the overall departmental claims department quality.
  • Bachelors or Associates degree preferred.
  • Supervisory or related experience preferred.
  • Five or more years work experience in handling health insurance or self-funded claims.
  • NYS A&H Adjuster license (to be obtained within 3 months of employment)
  • Familiarity with industry terminology and claim related medical terminology.
  • High level of organizational and problem solving skills.
  • Excellent written and verbal communication skills.
  • Team player and willing to collaborate with management team.
  • Good computer skills, including use of MS Word and Excel.

Recommended skills

Verbal Communication
Computer Literacy
Corrective And Preventive Actions
Customer Service
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