Claims Supervisor

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Claims Supervisor to join our growing team.

Job Summary:

The Claims Supervisor is responsible for overseeing the daily operations of the claims processing team, ensuring timely, accurate, and compliant adjudication of medical claims. Reporting to the Medical Claims Manager, this role provides direct supervision, coaching, and support to Claims Resolution Specialists and related staff while reinforcing operational standards and performance expectations.

This position supports the execution of departmental goals by monitoring productivity, resolving escalated claim issues, and ensuring adherence to service level agreements, regulatory requirements, and internal policies. The Claims Supervisor plays a key role in maintaining quality, improving processes, and driving consistency in claims operations.

*Although not required, this role has a preference for candidates who are able to work on site at our call center in Cheyenne, Wyoming.

Responsibilities:

• Provide direct supervision to claims processing staff, including Claims Resolution Specialists and related roles.
• Monitor employee performance and provide regular coaching, feedback, and support.
• Support employee development, training, and performance improvement efforts.
• Foster a collaborative, accountable, and quality-focused team environment.
• Supervise daily operations of claims processing staff to ensure timely and accurate adjudication of claims in accordance with policies and procedures.
• Monitor team productivity, quality, and timeliness to ensure service level agreements and performance standards are consistently met.
• Review claims, adjustments, and appeals for accuracy, completeness, and compliance with medical necessity and policy guidelines.
• Serve as the primary escalation point for complex claim issues, providing guidance and resolution support to team members.
• Research claim issues to identify root causes and implement corrective actions to prevent recurrence.
• Ensure accurate entry of payment adjustments and proper documentation within claims systems.
• Monitor data entry accuracy to support reporting, tracking, and audit readiness.
• Provide ongoing coaching, feedback, and development support to team members to improve performance and capability.
• Assist in training new hires and reinforcing workflows, policies, and system processes.
• Support performance management activities, including evaluations, corrective actions, and recognition.
• Identify operational trends and recurring issues and escalate recommendations for process improvements to the Claims Manager.
• Troubleshoot claim processing issues across departments, including authorization, appeals, transportation, and financial processing.
• Ensure compliance with HIPAA, Medicaid regulations, and applicable privacy and security standards.
• Develop and review reports related to productivity, quality, and operational performance.
• Communicate effectively with internal stakeholders to resolve inquiries and support operational needs.
• Utilize multiple systems and platforms to verify eligibility, claims status, and required documentation.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications

• 1+ year(s) of experience in a lead or supervisory role within a claims or healthcare operations setting
• Experience in claims resolution, adjustments, and research of claim-related issues
• Working knowledge of medical terminology and claims processing standards
• Strong attention to detail and ability to ensure accuracy and compliance in a high-volume environment
• Effective communication and problem-solving skills with the ability to support and guide team members

Preferred Qualifications

• Bachelor's degree in healthcare, business, or related field
• 3+ years of experience in medical claims processing or a similar environment
• Familiarity with medical billing forms, ICD-9/10-CM coding, CPT coding, and related coding schemes
• Certification in medical coding
• Experience in a managed care, Medicaid, or government-regulated claims environment
• Experience working in a high-volume claims processing operation
• Familiarity with multiple claims systems and data platforms

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

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