Supervisor Operations - Claims Processing | 40% RemoteAlpha Business Solutions • Philadelphia, Pennsylvania, United States
Supervisor Operations - Claims Processing | 40% Remote
Alpha Business Solutions
- Philadelphia, Pennsylvania, United States
- Philadelphia, Pennsylvania, United States
À propos
Philadelphia, PA 19103
Contract-to-Hire | Will convert to full-time in 3 months
Pay rate: $40/HR - W2
The Supervisor of Operations – Offshore Vendor Oversight is responsible for the day-to-day operational oversight, performance management, and quality assurance of an offshore claims processing vendor supporting Independence’s Claims Processing operations. This role ensures that all vendor-managed functions are completed promptly, accurately, professionally, and in compliance with contractual, regulatory, and departmental requirements.
The Supervisor serves as the primary operational liaison between Independence and the offshore vendors, providing direction, guidance, issue escalation, and continuous improvement oversight to ensure service levels and customer experience expectations are consistently met.
Important notes:
This is basically a claims operations supervisor/vendor management type of candidate.
Someone who understands claims processing well enough to support and guide offshore teams, manage QA/training/performance, and keep multiple vendor teams aligned with the onshore claims team.
Hybrid schedule, onsite 3 days per week
Acts as liaison between onshore claims teams and two offshore vendor partners, primarily working with vendor leads Serves as liaison between offshore SMEs and offshore training teams to ensure process alignment and consistency.
They will be working with two offshore vendors – total of 60 or less offshore combined.
Will primarily be speaking with the leads. Ensuring that staff is meeting performance metrics Oversees Bluecard and local Adjustment and clean claims Potential travel to India – will need to have a passport and be willing to travel.
Person needs to know how to process claims but will not be generally processing day to day as a supervisor.
The team members they support will process. They will also get a lot of questions from the offshore teams.
They will not have direct reports until they convert perm.
Vendor management 8am – 4pm are core hours, but potential to have to work longer hours or weekends Based on a 40 hour week Virtual interviews are fine
Responsibilities: Provides operational oversight and governance of offshore vendor claims processing activities. Ensures vendor compliance with contractual service level agreements (SLAs), key performance indicators (KPIs), quality standards, and regulatory requirements. Monitors daily, weekly, and monthly vendor performance metrics including productivity, accuracy, turnaround time, and quality results. Evaluates operational effectiveness and efficiency of vendor-managed workflows and partners with the vendor to reallocate resources or adjust processes as needed. Serves as the primary point of contact for operational issues, escalations, and resolution of vendor-related concerns. Collaborates with internal stakeholders (Claims Operations, Quality, Compliance, IT, Finance, and Vendor Management) to coordinate vendor activities and resolve issues. Communicates, interprets, and enforces corporate and departmental policies, procedures, and process changes with the offshore vendor. Leads root cause analysis for errors, defects, or service failures and ensures corrective action plans are implemented and sustained. Supports implementation of new initiatives, system enhancements, and process changes involving the offshore vendor. Reviews and validates vendor training plans to ensure staff are properly trained on claims processing, systems, and Independence requirements. Provides ongoing feedback and coaching to vendor leadership to drive performance improvement and service excellence. Ensures all inquiries, follow-ups, and escalations handled by the vendor are resolved in a professional, accurate, prompt, and courteous manner. Compiles, analyzes, and prepares operational reports related to vendor performance, trends, risks, and improvement opportunities. Maintains department standards to ensure an optimal customer and provider experience. Ensures systems, tools, and support processes required for vendor operations are functioning effectively. Encourages a culture of accountability, continuous improvement, and partnership with the offshore vendor. Performs all other appropriate responsibilities and duties as assigned. Qualifications - External Minimum of five (5) years of related insurance operations experience, with demonstrated experience in claims processing. Prior experience overseeing or working with offshore or third-party vendors strongly preferred. Demonstrated ability to handle sensitive operational, quality, and performance issues with tact, diplomacy, and professionalism. Strong vendor management and relationship management skills with the ability to influence without direct authority. Proven ability to analyze performance data, identify trends, and implement corrective actions. Excellent organizational, planning, and time management skills in a fast-paced, high-volume environment. Ability to prioritize work and adapt to frequently changing operational demands. Strong oral and written communication skills, including the ability to clearly convey expectations, feedback, and performance results to vendor partners. Ability to work independently with minimal guidance while maintaining accountability for outcomes. Experience in high-volume claims processing operations strongly preferred. Knowledge of Claims processing both local and BlueCard business, processes, and applications preferred. HealthRules experience preferred.
Please apply with your interest. You may also reach out to me at
Thank you,
Ashu
We provide a comprehensive package which includes.
Benefits Medical for full time employees Dental, and Vision Insurance Life Insurance, Short-Term Disability, Long-Term Disability, etc.
Compétences linguistiques
- English
Avis aux utilisateurs
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