1. JOB PURPOSE The claims supervisor directs the activities of staffs who are adjudicating and finalizing Pre-authorizations and claims. As a subject matter expert to take an initiative in assisting team requirements pertaining to the operational software and tasks related to the policy coverage terms. 2. RESPONSIBILITIES AND DUTIES § Perform job supervisory duties to assure proper training, instructions, and development of staff. § Control claims cost by all permissible, equitable, fair means. § Closely coordinate with the Assistant Manager-Claims and CMO on staff performance reviews and leave scheduling; § Delegate and oversee activities performed by claims and authorizations examiners. § Daily monitoring of pipelines and queues (not limited to claims, calls and authorizations only). § Identify training requirements within the team and perform training sessions. § Responsible in maintaining the assigned TAT of the respective teams and ensuring the optimal utilization of resources. § Co-ordinate with payers and providers whenever required in order to ensure smooth operation of the department § Address any complaint raised by customers and escalate to the concerned personnel if required. § Address any internal grievances and escalate to CMO if required. § Responsible for analyzing Claims Fraud, Waste and Abuse trends and escalating to concerned parties § Co-ordinate with Software development team in case of any bugs or new requirement on the system § Identify gaps in performance and offer coaching to officers as needed. § Proper communication and identifying training requirements within the team. § Strictly applies Chief Medical Officer (CMO) directions. § Carry out any other related functions as directed by the company management.