Company :

Job Description : 

JOB SUMMARY

This job supervises and coordinates the day to day activities of the various claims processing or claims adjustment units responding to internal inquiries or inquiries received by members, providers, or account representatives across all markets.

ESSENTIAL RESPONSIBILITIES

• Communicate effectively.
• Effectively supervise all assigned personnel.
• Coordinate any claim backlog distribution for regular and overtime work both interdepartmentally and companywide. 
• Monitor and manage daily inventories to ensure adequate staffing and resources are available.
• Subject matter expert for benefit plan and claims processing issues, implementation of new groups and products, and transition meetings.
• Research quality issues and respond to error assessments.
• Ensure all business processes are routinely monitored.  Recommend and design, if necessary, process improvements designed to improve accuracy, timeliness of process and/or eliminate manual effort.
• Other duties as assigned or requested.

This positions supervises employees mostly in the State of New York: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming counites.

Required

• High School Diploma or GED
• 2 years experience in a claims environment
• 1 year experience leading or supervising others

Preferred

• Bachelor’s degree

SKILLS

• Knowledge of multiple processing systems and workflows
• Knowledge of claims processing methodologies
• Ability to interpret all government regulations.
• Knowledge of Highmark products.

Travel Requirements

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Remote Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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