UNITE HERE HEALTH Claims Supervisor in Aurora, Illinois

Looking for a way to influence the health and healthcare of many?

If so, we’d love to hear from you! Our mission-driven organization is focused on the“Triple Aim” - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.

UNITE HERE HEALTH serves 100,000+ workers and 220,000 covered lives in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

Key Attributes:

  • Integrity – Must be trustworthy and principled when faced with complex situations

  • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required

  • Communication – Ability to generate concise, compelling, objective and data-driven reports

  • Teamwork – Working well with others is required in the Fund’s collaborative environment

  • Diversity – Must be capable of working in a culturally diverse environment

  • Continuous Learning – Must be open to learning and skill development. As the Fund’s needs evolve, must be proactive about developing new areas of expertise

  • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)

The Technical Claims Supervisor is responsible for interacting with all levels of the organization to analyze business process, benefit design and workflow efficiency. This individual serves as a subject matter expert for how claim systems and programs can support organizational goals. The Technical Claims Supervisor will frequently be required to partner with internal and external customers and vendors to design best practices for system application across multiple lines of business. This individual will manage a team of direct reports dedicated to plan building and testing of various products such as major medical, vision, dental, life and short-term disability.

Essential Job Functions:

  • Study existing process flows to evaluate effectiveness and develop new processes, programs or plan builds to improve processor experience or auto-adjudication

  • Prepare and analyst testing results to evaluate quality and auto-adjudication rates of new plan builds

  • Evaluate proposed benefit design changes for ability to auto-adjudicate and/or ability to implement programatically

  • Assist programmers in resolution of production issues related to existing programming or in the design of program changes to increase auto-adjudication or support business needs

  • Evaluate programming interation with claim system application

  • Assist in the assignment and coordination of project work such as release testing, benefit changes, new plan implementation and operational optimization

  • Consult with business units to analyze current processes and procedures, evaluate problems and learn specific input and output requirements to design technical solutions within the claims processing application or supporting programs

  • Manage team inventory to ensure that departmental metrics are consistently met

  • Demonstrate depth of knowledge necessary to identify and report on trends and forecast staffing needs

  • Demonstrate necessary competence in technical, industry standard and soft skills to effectively support and develop staff

  • Maintain a team dynamic consistent with departmental and organizational culture

  • Act as a subject matter expert on designated projects and support departmental training activities

  • Demonstrate the ability to triage and track complex issues to satisfactory resolution

  • Communicate effectively with all levels of the organization as well as external vendors

  • Actively support change with a positive attitude

  • Demonstrate accountability for personal actions as well as team and departmental results

  • Demonstrate ability to successfully investigate and respond to escalated inquiries from internal and external sources

  • Plans, analyzes, and evaluates programs and services, operational needs, and fiscal constraints

  • Supervises, leads, and delegates work and coaches, mentors, develops employees

  • Analyzes problems, identifies and develops alternative solutions, projects consequences of proposed actions, and implements recommendation/solutions

  • Recommends hires and promotions, directs and evaluates employment decisions for all assigned positions

  • Assists with developing and coordinating policies and procedures

  • Responsible for the oversight of continued employee training requirements, safety and quality initiatives

  • Performs other duties as assigned within the scope of responsibilities and requirements of the job

  • Performs Essential Job Functions and Duties with or without reasonable accommodation

  • High School Diploma or GED

  • Bachelor's degree preferred

  • 4 6 years of related experience minimum

  • 12 years of supervisory experience

  • 2 + years of major medical claim processing experience

  • 12 years of experience with data files such as flat, XML, 837 & 835 preferred

Skills and Abilities:

  • Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)

  • Intermediate level Microsoft Excel skills

  • Basic level SQL query writing skills

  • Ability to work collaboratively with superiors, peers and subordinates

  • Ability to provide effective leadership

  • Ability to analyze data and present findings and/or make recommendations based on results

  • Ability to hold constructive meetings

  • Ability to work effectively in a collaborative team environment

ID: 2018-1499


External Company URL: https://www.uniteherehealth.org

Street: 711 N. Commons Drive