Exton, Pennsylvania
Operations Supervisor (Healthcare Benefits- Exton) Job Opening in Exton, Pennsylvania - West Health Advocate Solutions in Exton, PA is currently seeking an Operations Supervisor . The successful candidate will be responsible for supervising workflow of all incoming benefits calls and cases including medical, dental, pharmacy, vision and other services. This includes developing and implementing policies and procedures, training staff to perform specific functions and managing employee performance, monitoring calls and auditing case files daily to ensure the proper target resolution is identified and that, if possible, the case is closed.
This position requires experience and working knowledge with healthcare benefits. Applicants should be able to call out there experience working with healthcare benefits within their resume and during the interview process. Experience working within a call-center environment is crucial, as this supervisor role will supporting the needs and daily operations of a fast-paced, call-center staff.
Additional responsibilities include:
Implementing actions to resolve any case deficiencies which includes reviewing results with employees
Reviewing operational reports and analyzing staff needed to make the necessary adjustments and or plans to improve results
Adherence to hours worked and time spent resolving cases
Case documentation
Analyzing data reports to make timely decisions and effectively implementing plans
Minimum Qualifications:
Education
Associate's degree from an accredited college or university with major course work in business administration, liberal arts, public health, healthcare management, or a related field required
Experience
Minimum of 3 years of healthcare, health plan or benefits experience required preferably in a call center environment
Minimum one year lead or supervisor experience preferred
Based on department or area of assignment the following may be required:
Minimum 2 years of health benefits experience
Other
Intermediate knowledge of Word and Excel is required
Ability to search and identify resources through company Intranet and Internet
Based on department or assignment knowledge of the following is preferred:
Group Health Plans (fully insured and self-insured)
Summary Plan Documents (SPDs) and Certificates of Coverage (COCs)
Government programs, resources and legislation and mandates including but not limited to Affordable Care Act, FMLA, Medicaid, CHIP
COBRA
Medicare A, B, MediGap, Supplement plans, Medicare Advantage, Medicare Part D plans
High deductible health plans including Health Reimbursement Accounts (HRAs) and Health Saving Accounts (HSAs)
Flex Spending Accounts (FSA), including limited FSAs
Coordination of benefits and which plan is primary - simple and complex cases (commercial plans, Medicare plans)
Individual Health Plans and Exchanges plans
Reviewing, interpreting, and researching Explanation of Benefits (EOB's) and denial letters
Understanding of health plan authorizations, including medical policy and claims payment guidelines to evaluate if appeals require clinical or administrative review
Knowledge of applicable law and resources regarding confidentiality of privileged patient information and appeals administration
Understanding of insurance carrier claims processing
Knowledge of procedure and diagnosis coding (ICD-9, HCPCS, and CPT-4)
Pharmacy benefits including injectable medications
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Job Type: Full-time
Required education:
Associate
Required experience:
supervisor: 1 year
healthcare benefits or health plan: 3 years
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