Medical Claims Supervisor

Position Overview

We are seeking an experienced Medical Claims Processing Supervisor to lead a team responsible for insurance verification and benefits research supporting patients prescribed complex and high-cost drug therapies.

This role combines people leadership with hands-on operational oversight. The Supervisor will be responsible for coaching and developing Medical Claims Processors, monitoring productivity and quality, reviewing work, resolving escalated cases, and ensuring the team consistently follows client requirements, documented procedures, and business rules.

Lead, coach, and support a team of Medical Claims Processors responsible for insurance verification and benefits investigation.

Monitor productivity, quality, accuracy, and adherence to established processes and provide coaching when performance gaps are identified.

Ensure team members follow client requirements, documented procedures, work instructions, and business rules.

Provide guidance on complex insurance coverage questions, discrepancies, and escalated cases.

Oversee team workflow and schedules to maintain appropriate coverage and achieve daily productivity expectations.

Identify potential staffing needs or workflow concerns and escalate recommended adjustments to management.

Conduct timely performance evaluations and provide ongoing feedback, coaching, and development.

Address employee performance and corrective-action matters in accordance with company policies.

Requirements

Minimum Qualifications

• High school diploma or equivalent; bachelor’s degree preferred.
• At least 2 years of experience in back-office operations, healthcare administration, insurance verification, benefits investigation, claims processing, pharmacy operations, or a similar operational environment.
• At least 1 year of supervisory experience.
• Strong leadership, coaching, and mentoring skills.
• Strong analytical, research, and problem-solving abilities.
• Excellent written and verbal communication skills.
• Strong organizational skills and attention to detail.
• Ability to effectively manage multiple priorities in a fast-paced, productivity-driven environment.
• Proficiency with Microsoft Office, including Word, Excel, PowerPoint, and Outlook.

Preferred Qualifications

• Medical claims, health insurance, benefits investigation, insurance verification, specialty pharmacy, or related healthcare experience strongly preferred.
• Working knowledge of medical insurance concepts and terminology, including eligibility, deductibles, copays, coverage limitations, and prior authorizations.
• Experience leading teams responsible for high-volume transactional, claims, insurance, healthcare, or other detail-intensive back-office work.
• Experience monitoring and coaching employees against productivity, quality, and accuracy expectations.