Claims Processing Supervisor

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what.

The Claims Processing Supervisor is accountable for developing and overseeing claims processing to ensure compliance with contractual and regulatory requirements as it relates to the accurate and timely adjudication of clean, corrected, and correspondence claims.

This role is different because the Claims Processing Supervisor at WelbeHealth:

• Operates within a highly collaborative, mission-driven PACE model, partnering cross-functionally with clinical, finance, compliance, and operations teams to directly impact participant care and provider experience
• Plays a key role in shaping claims strategy and compliance in a complex, highly regulated Medicare and Medicaid environment, with visibility to leadership and influence on organizational outcomes

We care about our team members. That’s why we offer:

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• 401K savings + match
• Comprehensive compensation package including base pay and bonus
• And additional benefits!

On the day-to-day, you will:

• Manage the team’s daily activities and performance related to claims processing KPIs
• Develop and utilize monitoring functions to oversee provider inquiries, claims, and recovery disputes to ensure proper documentation and resolution
• Collaborate with internal stakeholders on findings, remediation, and reporting, as well as make recommendations related to identified trends or improvements, working with management and staff in other departments to implement changes
• Create and update team procedures, workflows, and resource materials
• Serve as the primary resource and point of escalation for claims processing related issues
• Provide direct supervision, support, and guidance to team members, as well as identify training gaps and opportunities for improved performance
• Evaluate team member performance and provide feedback, coaching, and counseling when performance issues arise

Job requirements include:

• Associate’s degree preferred; relevant professional experience in a health plan environment with an emphasis on billing, claims payment, coding, or other closely related functions may be substituted
• Minimum of two (2) years of experience in health plans (managed care or PACE strongly preferred)
• Minimum of two (2) years of supervisory experience with the demonstrated ability to mentor team members in a claims processing environment is required
• Working knowledge in Medicare or Medicaid billing and guidelines, with the ability to understand and analyze contractual and regulatory requirements and their effect on claims payment and resolutions is required
• Comprehensive knowledge of claims processing and regulations, strong problem-solving skills, and the ability to analyze problems and formulate solutions
• Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects

We’re seeking a Claims Processing Supervisor that ideally has experience leading claims operations within a managed care, Medicare, Medicaid, or PACE environment, with a strong focus on compliance, process improvement, and team development. If you’re ready to join a team that values both its participants and team members, we’d love to hear from you!