Reporting to the Director of Claims, the Supervisor, Claims Processing organizes and supervises the work of Claims staff and leads daily operations according to industry and SFHP standards.

The Supervisor, Claims Processing ensures the processing of claims complies with all regulatory and contractual requirements. You are responsible for the performance of Claims staff under their supervison, participates in cross-functional projects and audits, creates claims reports and desktop procedures, resolves claims issues, and achieves departmental goals.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $88,000 - $103,000 per year

WHAT YOU WILL DO:

• Ensures claims processing follows all regulatory and contractual requirements, and that Claims departmental metrics are met.
• Works diligently to ensure accurate claims payment and associated documentation (remits). Identifies trends and resolutions to reduce provider disputes.
• Addresses escalated issues in accordance with policies, procedures, and regulations.
• Reviews and processes complex claims when needed.
• Monitors staff's work regularly for quality and efficiency. Provides training, feedback, coaching, and disciplinary action to staff, if necessary. Supports staff in meeting standards, solving problems, and enhancing performance.
• Works collaboratively with other departments to resolve issues efficiently. Identifies and communicates problems to the Director, Claims timely.
• Works closely with Claims Quality Assurance team to review audit findings, provide feedback, resolve issues, and improve claims accuracy.
• Consults with Director, Claims to develop and revise policies and desktop procedures for the Claims team
• Communicates goals to staff members and motivates them to achieve departmental goals.
• Participates in cross-functional projects to support and enhance operational processes.
• Maintains good communication and relationships with staff, providers and stakeholders.
• Leads department participation in all regulatory and financial audits, including resolution of audit findings.
• Keeps abreast with claims related to SFHP policies, procedures, and regulations.

WHAT YOU WILL BRING:

• At least five years of experience in managed health care and Medi-Cal and/or Medicare program.
• One to three years of management experience.
• Experience with standard claims processing and claims data analysis.
• Solid working knowledge of claims coding and medical terminology.
• Superb skills in collecting and analyzing data.
• PC proficiency including but not limited to MSOffice skills (Outlook, Word, Excel, and PowerPoint).

WHAT WE OFFER:

• Health Benefits
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

#LI-Hybrid

(Hybrid remote/in-office)