• Supervisor - Claims Support

    Job Locations US-FL-Tampa
    Job ID
  • Overview

    This position supervises a team of non-exempt associates within assigned unit in Operations. Monitors performance and productivity of individuals and the team and takes appropriate action to ensure department goals are met including, but not limited to regular scheduled and just-in-time coaching, recommending re-training, performance management and mentoring associates. Manages payer, provider and patient complaint resolution. Consistently identifies areas of opportunity/process improvement within department and recommends solutions as necessary.

    Position Summary for Appeals and Recoupment Area:

    Supervises the day to day operations of CareCentrix appeals, recoupment processing and related activities in accordance with company policies and procedures. Ensures that all facets of appeals and recoupments are processed in a timely, accurate and efficient manner and in accordance with both provider and carrier contracts.


    • Works with team leads to ensure service level metrics are achieved through regular scheduled and just-in-time coaching. Monitor inbound phone queues and track inbound calls.
    • Works to ensure all staff metrics are created/adjusted as necessary as well as clear communication to all staff around expectations.
    • Supports management in driving strategic direction at the lead and staff level.
    • Support leads on escalated interactions to include tracking, trending and appropriate strategic business recommendations.
    • Works with team leads and staff employees to drive efficient call volume activity and management through communication with the Workforce Management Team and call queue monitoring.
    • Supports cross-functional process improvement efforts.
    • Keeps abreast of technological and industry developments/ best practices.
    • Processing of all direct reports timecards and ensuring all associates are completed meeting all appropriate deadlines.
    • Motivate staff - Reward and recognize associates monthly and/or as necessary for performance above and beyond expectations.
    • Perform interviews for new hires and tracking for all requisitions at the lead associate and associate level.
    • Monthly feedback sessions for staff to include performance action plans as necessary.
    • Ensures appropriate staff training, cross training, evaluates staff performance and recommends hiring, terminations, promotions and salary action.
    • Develops and oversees training and quality assurance programs to assure continuous quality and productivity improvement.
    • Other duties as assigned.

    Position Summary for Appeals and Recoupment Area:

    • Manage appeal and recoupment process/workflow for CareCentrix.
    • Monitors all processing results, anticipates and avoids problems. Escalates issues as appropriate to senior management in a timely and effective manner, following through until resolved.
    • Provides timely guidance and assistance to other departments regarding appeals/recoupment processing.
    • Manages all appeals/recoupment processing to ensure appropriate communication and feedback as well as timely process improvement.
    • Ensures appropriate staff training, cross training, evaluates staff performance and recommends hiring, terminations, promotions and salary action.
    • Participates in regional line management meetings. Provides timely and accurate reports of all key performance and processing metrics.
    • Develops and oversees training and quality assurance programs to assure continuous quality and productivity improvement.
    • Establishes monthly goals for each team within the claims centers and evaluates performance, e.g. days claims outstanding, adjudication productivity and overall accuracy.
    • Ensures that appeals and any recovery of provider payments are researched and processed in a timely and proper manner.
    • Interacts with other departments to improve processes and procedures so that overall operations and financial results are improved.
    • Performs all duties inherent in a Supervisory role. Encourages and fosters an environment of teamwork, communication, collaboration and readiness for change.
    • Participates in special projects and performs other duties as assigned.


    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
    • This position requires excellent communication (verbal and written), customer service and analytical skills as well as the ability to interact with all levels of management and a highly diverse population.
    • Must have strong organizational and interpersonal skills and be able to effectively manage and prioritize multiple tasks, and demonstrate independent thought and critical thinking skills.
    • Must be detail oriented, be responsive, problem-solve difficult situations with internal and external customers and with process and/or systems issues.

    • Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
    • Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
    • Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
    • Reviews and adheres to all company policies, procedures, and the Employee Handbook.

    • Must be able to remain in a stationary position 90% of the time.
    • Occasionally move about the office to access file cabinets, office machinery, etc.
    • Constantly operates a computer and other office productivity machinery (i.e., a calculator, copy machine, and computer printer).
    • Frequently communicates via phone and email. Must be able to exchange accurate information in these situations.
    • Occasionally lift items weighing up to 10 pounds.


    Associate’s Degree or the equivalent plus a minimum of two years of experience in a lead/supervisory role generally required. Demonstrated success in leading others. A minimum of 2 years of experience in operations, preferably in the medical, insurance or healthcare field is also required. Knowledge of Excel, Word and Outlook is also required.

    CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.


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