OneMain Financial Jobs

Hybrid: Applicants must be a California resident as of their first day of employment

PRINCIPAL RESPONSIBILITIES:

Under general direction from the Manager, Claims Operations Support, the Supervisor, Claims Specialist is responsible for the day-to-day supervision of Claims Specialist roles, collaborating with other department Supervisors and other department leadership members, in order to meet and exceed performance targets. Specialist staff activities include, but are not limited to, research and resolution, auditing, refund processing and claims system analysis/testing.

The Claims Specialist Supervisor is responsible for ensuring that processed claims are reviewed and audited to help assess work performance, assist in identifying training needs and opportunities for workflow and system configuration improvements. The Supervisor also oversees staff responsible to provide testing of system functionality on new and existing products, and to receive and respond to requests for assistance on Service Requests and Provider inquires in a timely and accurate manner by communicating and enforcing department goals and objectives within a total quality management approach and in compliance with all applicable state/federal regulations. The Supervisor will assist the departments leadership team in monitoring and enforcing production and quality standards, ensuring compliance with all operating policies and procedures and claims processing guidelines, and collaborating with other departments to ensure the Alliances business, operating and reporting goals are met.

Other principal responsibilities include:

• Provide day-to-day supervision of Claim Specialists staff.
• Work with Manager, Claims Operations Support to develop, and implement unit production goals, then assign and monitor daily workload to ensure goals are achieved.
• Oversee the preparation of routine and ad hoc reports.
• Respond to escalated provider claim inquiries received by Provider Services, Grievance and Appeals and other Departments as needed.
• Provide advice to other Alliance departments on claims related issues by phone, email or in person.
• Prepare, review, and approve staff timecards, approve/deny requested time off, and monitor attendance.
• Hire, coach and develop staff to accomplish organizational objectives.
• Monitor and provide feedback on staff performance, recognizing strengths and coaching towards improved performance where necessary.
• Implement corrective action plans and discipline as necessary.
• Conduct scheduled performance appraisals in a timely and thoughtful manner.
• In conjunction with the Claims Production Manager, Claims Trainer and Claims Processing Supervisors, assemble and maintain training guidelines and tools.
• Conduct monthly one-on-one meetings with staff.
• Conduct weekly team meetings.
• Review Inventory, Quality and Production reports weekly.
• Review and improve Service Request workflow. Suggest improvements to current departmental workflows and systems.
• Monitor Service Requests and adjustment projects to ensure timely completion.
• Oversee all system testing activities related to new software implementation, system upgrades or routine system configuration changes.
• Ensure that the Department adheres to all state and federal regulations, contract requirements, and service level agreements.
• Assist in the preparation for all internal, external and regulatory audits.
• Represent the Alliance, as needed, during internal or exernal audits of Alliance claims processing.
• Perform other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Hire, train, lead and evaluate staff; build an effective team and assist in ensuring appropriate staffing and staff development.
• Identify problems, perform appropriate analysis and determine options for resolution.
• Collect needed data, information and/or analyses to assist in r solving complex claims issues and/or large volume claim adjustment projects.
• Produce reports on daily, weekly, and on an ad hoc basis.
• Communicate effectively and efficiently, internally and externally, in written and verbal formats.
• In collaboration with the Claims Trainer and Claims Processing Supervisors, develop and maintain documented claims procedures as a routine function.
• Ensure system configuration changes are producing the expected results.
• Respond to inquiries from other Alliance departments on claims related issues via phone, email or in person.
• Lead and/or participate in internal committees and meetings.
• Comply with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or on a computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Constant use of telephone headset.
• Constant verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.

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