Eligibility Specialist Supervisor -Memphis

Description

Department: Verification Department

Reports To: Operations Manager

Summary of Responsibilities

The Eligibility Specialist Supervisor is responsible for overseeing the workers’ compensation claims department. This role drives operational efficiency through the continuous analysis and improvement of processes, data integrity, and team performance. The supervisor will identify and implement strategic enhancements that streamline operations, reduce manual efforts, and ensure data accuracy, while also fostering a high-performance culture.

Key responsibilities include reviewing all claim files to identify opportunities for automation, minimizing manual intervention, and ensuring data completeness. The role includes handling and resolving complex claims, leveraging process optimization strategies, and ensuring that all operations are aligned with regulatory requirements and best practices. This position plays a pivotal role in transforming claims management through process redesign and efficiency initiatives.

The supervisor will also lead, mentor, and develop team members, fostering a culture of accountability and continuous improvement. They will proactively manage department performance, identifying areas for improvement and driving the team towards operational excellence.

Key Responsibilities:

• Lead process improvement initiatives to streamline workflows and reduce operational bottlenecks in claims verification and resolution.
• Collaborate with cross-functional teams to optimize processes and integrate best practices across departments.
• Oversee and monitor department performance metrics, ensuring efficiency targets are met and continuously refined.
• Identify and implement strategies to reduce manual tasks, enhance automation, and improve data integrity.
• Analyze and assess claims data, identifying trends, inefficiencies, and opportunities for process optimization.
• Lead department through complex verification processes, minimizing manual interventions and optimizing data collection workflows.
• Drive a culture of continuous improvement by regularly reviewing team performance, identifying gaps, and implementing training to enhance efficiency.
• Manage Employer and Carrier databases, ensuring upstream processes are optimized and automated.
• Interview, hire, and train team members with a focus on developing process improvement skills and leadership qualities.
• Collaborate with management to communicate key performance trends, improvement opportunities, and results.

Requirements

Required Education & Experience:

• High school diploma required; some college experience preferred.
• 2+ years of experience in workers' compensation claims processing or a related field.
• 2+ years of leadership or supervisory experience, with a proven track record of driving operational efficiencies.

Required Qualifications, Skills, & Knowledge:

• Knowledge of Windows, Word and Excel or similar programs required.
• Excellent understanding and application of workers compensation claim check techniques
• Advanced investigative, curious and problem-solving abilities with the ability to multi-task
• Possesses initiative to identify what needs to be done and act before being asked
• Results driven; maintains commitment to achieving goals, even when faced with obstacles
• Develops others by using proactive coaching techniques and conducts regular meetings with subordinates and team members for ongoing leadership development
• Utilizes analytical thinking to approach complex problems and notices discrepancies/trends and can propose novel solutions
• Demonstrates personal accountability by focusing attention on what can be done to make progress, rather than focusing on limitations. Acknowledges own mistakes and seeks developmental feedback
• Displays interpersonal effectiveness by understanding team members’ strengths and weaknesses; can address team concerns in a positive way to bring about desired outcomes
• Mature, patient, and able to appropriately handle difficult situations