Coordination of Benefits Supervisor

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

Job Description:

JOB SUMMARY:

This role ensures timely, accurate processing of all aspects of the identification, investigation, and validation processes for Coordination of Benefits (COB) and related eligibility products. The position monitors, prioritizes and distributes work to assigned team(s). The incumbent will work to facilitate quality processing of cases according to policy and procedures and client service level agreements (SLA's). This individual will work to identify recoveries for assigned clients that meet or exceed forecasts and partnering with senior leadership to execute on short and long term production strategies.

JOB ROLES AND RESPONSIBILITIES:

1. 
   Schedules and prioritizes work, approves time off, conducts performance reviews, hires, and performs other supervisory responsibilities and enforces production, quality, and customer-service standards / SLAs. Addresses issues with the team as a whole and individually.
   
   4. Routinely utilizes expertise specific to coordination of benefits rules, regulations, methodologies, and audit tactics to ensure efficient day-to-day operation of the department.
   5. Ensures compliance with CMS, NAIC and state COB guidelines. Ensures team is following company and client expectations.
   6. Works closely with senior leadership to document policies, procedures, and processes. Maintains and improves COB/OHI processes by monitoring trends and addressing issues for process improvement.
   
   8. Fields client issues and complaints and decides on a course of action to resolve the matters.
   9. Select, develop, and evaluate staff to ensure the efficient operation of department.
   10. Collaborate, coordinate, and communicate across disciplines and departments.
   11. Ensure compliance with HIPAA regulations and requirements.
   12. Demonstrate Company's Core Competencies and values held within.
   13. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
   14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:

This role works under limited supervision in the execution of the positions day-to-day responsibilities. This role will be a key contact in the draft in, implementation and maintenance of policies and procedures specific to the department. The incumbent will have a sizeable amount of influence on departmental revenue figures through the provision of effective mentorship of more junior team members. This is a people management job with authority for all HR actions (hiring, firing, discipline, training, etc.) as well as assign work.

Requirements:

JOB REQUIREMENTS (Education, Experience, and Training):

* Minimum high school diploma plus five (6) years' experience in auditing healthcare/insurance operations specific to Coordination of Benefits or COBRX.three (3) years of which should be inclusive to leadership experience.
* History of demonstrated client focus and ability to achieve results.

* Good organizational, analytical and independent decision-making skills.
* Strong problem-solving skills with the ability to manage multiple priorities and meet associated timelines.
* Proficient with MS Office products including Microsoft Excel.

*SQL experience is a plus but not required.
* Specifications should support the essential functions identified in the job, assuring compliance with the Americans with Disabilities Act (ADA) and other such employment-related acts (i.e., ability to stand for long periods of time, ability to interact with customers or visitors, ability to lift up to 50 pounds, ability to travel).
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.