Job Responsibilities and Requirements

KEY RESPONSIBILITIES

*other duties as assigned*

The Supplemental Health Claims Supervisor is responsible for ensuring that all Wellness, Accident, Critical Illness, and Hospital Indemnity claims assigned to his/her team are accurately and fairly adjudicated in a timely manner according to plan provisions, established best practices, and within company, state and federal guidelines.  The Supervisor is responsible for ensuring operational excellence and collaborates with other members of the management team to improve operations beyond his or her team.

Managing the Claims Block

• Manage the prompt and accurate investigation, adjudication, and payment (where appropriate) of claims within established guidelines.
• Delegate, distribute, and monitor workflow within the department to meet turnaround times, improve efficiency, and realign caseloads to reduce or eliminate backlogs.
• Ensure that workflows, procedures, and best practices are followed to improve the accuracy, efficiency, and effectiveness of claim management.
• Utilize available reporting resources and file reviews to ensure that established department goals are being met.
• Continually improve and develop examiners’ skills relative to case strategy, decision-making, investigation, evaluation, and communication through file review and coaching.

• Ensure the Claims Management System is current and any changes are communicated.

Customer Service

• Ensure the achievement of specific customer service quality and production objectives as established.
• Promptly address clients’ needs and address complaints that may be escalated to you; track, identify, and address issues as appropriate.
• Develop, model, and maintain effective working relationships with external (policyholders, brokers) and internal (sales, underwriting, administration) contacts.

•  Assist in the sales process including Requests for Proposal (RFP), sales presentations, and training of sales personnel.

Subject Matter Expertise

• Provide technical, claim-specific guidance and direction of claims presenting complex or unusual issues.
• Ensure compliance with established procedures and assist with audit activities.
• Suggest changes to policy language as necessary and participate in the development of new products.
• Perform focus reviews and review Quality audit results.

• Review adverse determination letters for content and provide feedback as needed.
• Regularly meet with staff to discuss new procedures, and trends identified in quality reviews, reinforce training efforts, communicate results, share information or problems, and provide a forum for team building.

Leadership

• Accountable for the performance of the team; engage team members in talent management and development opportunities, and build a positive and respectful work environment.
• Make personnel decisions on hiring, firing, discipline, transfer, advancement, and promotion in accordance with Company policies and procedures.
• Oversee the implementation and measurement of “best practices” to continually enhance the team's efficiency and effectiveness.
• Model and drive RSL’s values.

Miscellaneous

• Any other job-related duty as deemed appropriate by management.

REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE

*or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience*

Required Knowledge, Skills, Abilities, and/or Related Experience

• High School Diploma or equivalent required.  Associate’s or Bachelor’s Degree is highly preferred.
• 5 years of experience in the Group Claims industry, or at least 2 years of Group Claims  
• Previous management experience desired
• Knowledge of claims, Supplemental Health products, and underwriting principles desirable
• Knowledge and experience working in group insurance with a focus on Supplemental Health claims
• Critical thinking and analytical skills with a passion for problem-solving and resolution
• Outstanding communication skills, able to listen and respond with professionalism and empathy, maintaining tact and diplomacy, often in stressful situations
• Demonstrated ability to lead change management initiatives
• Success in collaborating with and influencing key stakeholders across organizational boundaries and in a matrix environment
• Completion of HIAA, LOMA, or ICA courses desirable

Ability to Travel: Up to 10%

PHYSICAL REQUIREMENTS

When used in the description below, the following terms are defined as:

“Occasional”: done only from time to time, but necessary when it is performed

“Frequent”: regularly performed; generally an act that is required on a daily basis

“Continuous”: typically performed for the majority of an employee’s shift

Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand.  Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones.  Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law.

CORE VALUES

• Collaboration
• Compassion
• Empowerment
• Integrity
• Fun

The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job.

Work location may be flexible if approved by the Company.

What We Offer

At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you.

That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing.  

Our Benefits:

• An annual performance bonus for all team members
• Generous 401(k) company match that is immediately vested
• A choice of three medical plans (that include prescription drug coverage) to suit your unique needs.  For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account
• Multiple options for dental and vision coverage
• Company provided Life & Disability Insurance to ensure financial protection when you need it most
• Family friendly benefits including Paid Parental Leave & Adoption Assistance 
• Hybrid work arrangements for eligible roles
• Tuition Reimbursement and Continuing Professional Education
• Paid Time Off – new hires start with at least 20 days of PTO per year in addition to nine company paid holidays.  As you grow with us, your PTO may increase based on your level within the company and years of service. 
• Volunteer days, community partnerships, and Employee Assistance Program
• Ability to connect with colleagues around the country through our Employee Resource Group program

Our Values:

• Integrity
• Empowerment
• Compassion
• Collaboration
• Fun

EEO Statement

Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications.