Claims Supervisor – MedMutual Protect Full Time

This role is fully remote, with a strong preference for candidates located in the Central Time Zone.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary

Supervises assigned operations and staff engaged in claims processing activities. Ensures compliance with production standards while maintaining adherence to Company policies and procedures. Identifies operational issues, makes recommendations for improvements and aids in implementation of procedural and systemic changes.

Responsibilities

• Provides day to day supervision of operations and staff to meet production standards and regulatory requirements. Provides technical expertise and guidance and resolves complex or escalated issues. Administers staffing, performance management and training and development of staff.
• Controls and monitors claims inventory.
• Identifies problem areas and implements improvements in systems, training, business processes, and policies.
• Leads or participates in departmental or divisional projects. (15%)
• Acts as primary contact with vendors as applicable.
• Performs other duties as assigned.

Qualifications

Education and Experience:

• Bachelor’s degree in business or health care administration or related field.
• Equivalent education and experience directly related to the role may substitute for a degree.
• 7 years progressive health insurance operations experience, preferably in claims review and overpayment recovery or related credit and collections area.

Technical Skills And Knowledge

• Strong knowledge of claims operations and customer service policies, procedures and systems.
• Strong knowledge of claims adjudication, medical terminology, medical/hospital procedure and diagnosis coding and benefits interpretation.
• Intermediate MS Office Skills.

A Great Place To Work

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits And Compensation

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment In You

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

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