CLAIMS SUPERVISOR

The Claims Supervisor is responsible for overseeing daily operations and performance of a team of Claims Examiners who process medical, dental, and vision claims for Boon-Chapman, an independent Third Party Administrator (TPA). This role ensures accurate and timely adjudication of claims in compliance with client benefit plans, regulatory requirements, and internal quality standards. The Claims Supervisor will provide leadership, coaching, and support to the team while collaborating with internal departments and external partners to resolve issues, improve processes, and deliver excellent service.

Key responsibilities may include:

• Supervise daily activities of the claims processing team, ensuring claims are adjudicated accurately and within established turnaround times.
• Monitor and report on individual and team performance metrics (e.g., productivity, quality, timeliness).
• Conduct regular audits of processed claims to ensure compliance with client benefit plans, provider contracts, and applicable federal and state regulations (e.g., ERISA, HIPAA).
• Provide training, coaching, and performance evaluations for Claims Examiners to promote continuous improvement and professional development.
• Serve as a subject matter expert for medical, dental, and vision claim adjudication and escalation point for complex or high-dollar claims.
• Identify trends in claim errors or delays and collaborate with cross-functional teams to develop and implement corrective actions and process improvements.
• Participate in client audits and assist with the development and maintenance of claim procedures, training materials, and job aids.
• Ensure excellent service delivery by maintaining positive relationships with providers, clients, and internal teams.
• Performs other duties as assigned.

• High school diploma or GED required; Associate's or Bachelor's degree in Business, Healthcare Administration, or related field preferred.
• Minimum 5 years of experience in healthcare claims processing, including at least 2 years in a supervisory or lead role. Experience with medical, dental, and vision claims required.
• Proficiency in claims adjudication systems (e.g., Eldorado, Facets, Amisys, or similar). Strong knowledge of Microsoft Office (Excel, Outlook, Word).
• Familiarity with self-funded plan administration, provider billing practices, ICD-10, CPT, HCPCS coding, and coordination of benefits.
• Strong leadership, communication, problem-solving, and organizational skills. Ability to manage multiple priorities in a fast-paced environment.