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Medical Claims Supervisor, Out of Network

Company: Multiplan
Location: Irving
Posted on: September 13, 2019

Job Description:

Are you looking for a rewarding new position with an industry leader with a firm commitment to its employees? Join our team at MultiPlan! Founded in 1980, we are the industry's most comprehensive provider of healthcare cost management solutions. We have almost 1,000,000 healthcare providers under contract, an estimated 68 million consumers accessing our network products, and 40 million claims reduced through our network and non-network solutions each year.

JOB SUMMARY: The Supervisor is responsible for managing the day-to-day planning and operations of the Team. This position is also responsible for serving as a resource for problem solving; staffing, service evaluation and enhancement; and policies/procedures to ensure smooth and efficient operations.


1. Manage daily operations and processes within the department by monitoring employee workflow and inventory, including distribution of claims/work, when applicable.

2. Monitor compliance with all departmental policies, procedures, and workflows as well as interface with all other internal teams regarding procedural compliance.

3. Monitor departmental and individual performance metrics and take proactive action when necessary on a timely basis to maintain desired workflow outputs; acting upon variances when applicable.

4. Develop and implement workflow changes to improve service and production efficiency of the department; this may include collaboration with other teams.

5. Collaborate with the training team and all other internal teams to implement new and revised procedures; which may include suggested system changes or enhancements.

6. Train, mentor, motivat and oversee staff performance; including coaching when needed.

7. Manage and review complex and/or difficult claims or issues to determine best outcome.

8. Partner with internal and external contacts to achieve effective communications and maximum savings.

9. May act as a liaison in monitoring and supporting specific client, provider or departmental assignments through reporting and relationship building.

10. Oversight or research on special projects as assigned.

11. Select, develop, and evaluate staff to ensure the efficient operation of department.

12. Collaborate, coordinate, and communicate across disciplines and departments.

13. Ensure compliance with HIPAA regulations and requirements.

14. Demonstrate Company's Core Competencies and values held within.

15. 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.

Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.


The Supervisor impacts efficiency and effectiveness of team operations. This is a people management role that has the authority to initiate and communicate some HR actions (training, new processes, coaching, mentoring, etc.) but for others, such as hiring, salary adjustments, position change, termination, and other disciplinary actions, the incumbent collaborates on such issues with the next level. The incumbent must have the ability to exercise discretion and independent judgment to judiciously act in situations where specific guidelines may not apply.

* Minimum Bachelor's degree or HS Diploma (or GED) and 4 years of related experience

* Minimum 3 years' experience in healthcare industry; preferably with claims processing, auditing and/or customer service.

* Minimum 2 years' experience in a leadership role

* Required licensures, professional certifications, and/or Board certifications as applicable.

* Knowledge of claims processing and procedure.

* Knowledge of provider billing and collection practices.

* Knowledge of medical coding systems and commonly used medical data resources preferred.

* Communication (written, verbal, listening) problem solving, organization, time management, leadership, and coaching skills

* Ability to convey information clearly, effectively and objectively

* Ability to communicate and process detailed verbal and written instructions.

* Able to demonstrate teamwork, organization,prioritization,and time management.

* Ability to be detail oriented to ensure accuracy, including mathematical calculations

* Ability to maintain commitment to providing a level of service within established standards

* Ability to lead, motivate, manage, coach and mentor others

* Ability to elicit trust and credibility with all levels of the organization

* Ability to identify issues and determine appropriate course of action for resolution

* Ability to adjust/alter workflow and schedule to meet deadlines in a fast-paced environment.

* Ability to analyze data and arrive at a logical conclusion.

* Ability to make decisions using limited or incomplete data, when necessary situations arise.

* Ability to work independently and handle confidential information

* Ability to manage multiple projects at the same time.

* Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software

* 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 Out of Network Supervisor with MultiPlan, you will be part of an organization with a proud 30-year legacy of experience and growth. We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:
* Medical, dental, and vision coverage
* Life insurance
* Optional and dependent life insurance
* Short- and long-term disability
* 401(k) employer matching
* Paid time off (earn 20 days per year)
* Paid company holidays
* Floating holiday
* Tuition reimbursement
* Flexible Spending Account
* Employee Assistance Program

Summer hours = Memorial Day to Labor day we get off two hours early EVERY FRIDAY!!

Opportunity. Recognition. Satisfaction. Grow your career with MultiPlan!


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. .

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Keywords: Multiplan, Irving , Medical Claims Supervisor, Out of Network, Healthcare , Irving, Texas

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