Insurance Specialist

  • location: Roseville, CA
  • type: Permanent
  • salary: $70,000 - $90,000 per year
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job description

Insurance Specialist

In conjunction with the Health and Welfare Claims Senior Manager, the Health and Welfare Claims Supervisor is responsible for day to day supervision of claims adjudication within the Health & Welfare Services Department:

The Health and Welfare Claims Supervisor will ensure that the daily work distribution of each unit. This includes but is not limited to daily review of performance metrics for each area and timely communication of- Improvement needed with specified staff, identifying areas of business process Improvement and possible solutions, and reviewing review and ensuring accuracy of timecards and adherence to with collective bargaining provisions, and appraisal documentation on a daily basis.

-Supervises claims processing leads and claims processors.
-Completes the daily work distribution to ensure daily claims activities of processing of medical,
dental, mental health and sick leave claims, payments to providers and members, stops payments
and reissues, recovery of overpayments, self-funded payments and collection arrangements, and as
needed, coordinates with other departments to ensure timely claims processing.
-Oversees the processing of specialty claims including third party claims, death benefits, PPOC,
MSPRC, and hospital claims.
-Recommends improvements to policies, standard operating procedures, and workflows to meet
department performance, quality and member goals, and implements as directed.
-Supervises and provides performance feedback, guidance, training, motivation, performance
appraisals, and support to staff.
-Coordinates and communicates with vendors to troubleshoot and resolve issues that prevent the
finalization of claims.
-Directs staff how to resolve routine and non-routine claims issues.
-Trains staff on completing and processing claims paperwork. Provides additional training and
support to staff as needed.

Working hours: 8:00 AM - 5:00 PM

Associate's degree in a related field and 3 years of related experience, including supervisory
- A combination of appropriate education and experience may be substituted for the minimum
education and experience requirements

Direct Hire
401(k), Medical, Dental, Vision 100% Employer Paid, Pension Plan
$70k?? to $90k per year

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