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Job Details

Claims Supervisor

Job Ref: 56352
Category: Claims
Department: CLAIMS
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $60,000.00
Salary Range: $60,000.00 - $70,000.00

Marketing Statement

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

This position acts as the lead employee for personnel involved in the adjudication of medical claims. Incumbent provides support to the manager and other MetroPlus employees regarding the adjudication of complex, difficult and non-routine for multiple lines of business. The incumbent will coordinate with the Manager to ensure the claims area maintains acceptable service levels.

Job Description

  • Supervise the day to day workload of the Claims Unit
  • Identify issues and problems with claims submissions
  • Identify system processing issues
  • Process complex, difficult and non-routine claims for multiple lines of business
  • Ensures that training manuals are current, and that policies and procedures are followed
  • Plans, Develops and Conduct training programs to maintain proficiency of staff
  • Provide input to the Manager related to the development and performance of employees
  • Allocates staff on basis of workload
  • Participate in special projects as required
  • Responsible for employee supervision, performance and employee development of assigned personnel in areas of responsibility and accountability
  • Supervise the unit in the absence of the manager

Minimum Qualifications

  • Bachelor’s Degree or related work experience 
  • Well versed in all the duties and responsibilities of Claims Examiner
  • Knowledge of Medicaid/MertoPlus policies, as well as enrollment policies procedures
  • Knowledge of HMO claims processing with a minimum of two (2) years’ experience
  • Excellent verbal and written skills
  • Must be able to work in a professional manner with employees, management, and providers

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication