CLAIMS SUPERVISOR JOB DESCRIPTION

Adjuster licensing requirements vary by state, and reserve authority sets the ceiling on every settlement decision a claims unit makes. Few supervisory roles carry both of those constraints simultaneously. A Claims Supervisor in property and casualty insurance manages a team of adjusters handling auto physical damage, general liability, and homeowner lines, owning reserve adequacy and coverage determinations up through their delegated authority level. Regulatory compliance with state-specific statutes governs how investigations proceed and how denial letters are issued.

As the Claims Supervisor, you ensure that a team of adjusters resolves property and casualty claims with technical accuracy, within reserve authority, and in compliance with state licensing and Unfair Practices Act requirements across all jurisdictions served. You typically report to a Claims Director or Regional Claims Manager, overseeing a unit of four to eight adjusters whose combined pending inventory spans personal and commercial lines.

Career Impact: Supervisory experience across auto, liability, and property lines, combined with multi-state adjuster licensing, positions a Claims Supervisor to advance toward Regional Claims Manager or Director of Claims within a carrier or third-party administrator.

Business Impact: Reserve decisions and settlement authority exercised at this level directly affect loss ratios, subrogation recovery rates, and the carrier's exposure on litigated files, outcomes that flow into underwriting pricing and financial reporting.

Growth Opportunity: Overseeing QA audits, catastrophe deployments, and litigation management develops a breadth of technical and operational skills that open pathways into claims operations leadership, compliance, or account management roles.

• Review and approve reserves and settlements that exceed adjuster authority levels, ensuring exposure accuracy on each pending file.
• Audit active and closed claim files monthly against best practices guidelines to identify coverage gaps, trends, and training needs.
• Direct coverage analysis and liability investigations across auto physical damage, third-party bodily injury, and property lines.
• Coordinate with defense counsel and independent adjusters on litigated files to drive timely, equitable resolution within budget.
• Develop and deliver technical training on coverage interpretation, damage estimating, and state regulatory requirements for the unit.
• Monitor subrogation and salvage identification across the team's inventory to maximize recovery for the carrier.
• Manage performance reviews, coaching plans, and disciplinary actions for a team of four to eight adjusters in accordance with company policy.
• Collaborate with underwriting and actuarial teams on litigation trends, reserve adequacy, and claims data that informs pricing decisions.

• Bachelor's degree in a related field or equivalent work experience.
• 7 or more years of claims handling experience in auto, general liability, or property lines, with demonstrated reserve and coverage authority.
• Active adjuster license in at least one state, with the ability to obtain multi-state licensure as required by the jurisdiction footprint.
• Proven supervisory or team lead experience, including performance management and coaching of claims staff.
• Strong working knowledge of coverage analysis, policy interpretation, and Unfair Practices Act compliance across multiple states.
• Demonstrated ability to manage litigated and non-litigated files simultaneously, including coordination with outside counsel.
• Excellent written and verbal communication skills, including the ability to prepare denial letters, major loss reports, and management presentations.
• Strong analytical skills with the ability to identify portfolio trends and develop actionable remediation plans.

• Industry designation such as AIC, SCLA, or CPCU, reflecting formal technical depth in claims and insurance operations.
• Experience supervising catastrophe claim handling, including deployment, extended hours, and multi-location coordination.
• Familiarity with damage estimating platforms and claims management systems used in property or auto lines.
• Prior experience managing a remote or geographically distributed team of adjusters across multiple jurisdictions.

• Reserve adequacy rate, measuring the percentage of files where set reserves match or exceed final settlement within defined tolerance.
• Cycle time from first notice of loss to file closure, benchmarked against unit service level agreements by claim type.
• Subrogation and salvage recovery rate as a percentage of total eligible files identified by the team each quarter.
• File audit compliance score across monthly open-file reviews, reflecting adherence to best practices and state regulatory requirements.
• Adjuster authority utilization rate, tracking how often files escalate above authority thresholds relative to total unit volume.
• Typical tools: Claims management systems (commonly Guidewire, Duck Creek); estimating platforms (commonly Xactimate, CCC ONE); productivity suite (commonly MS Excel, Word).

• Base Salary Range: $75,000 to $105,000 annually, depending on lines of authority and team size
• Bonus: Annual performance bonus, typically 8 to 15% of base salary
• Equity: Not commonly offered at this level in carrier or TPA environments
• Health Benefits: Medical, dental, and vision coverage; employer contribution standard
• PTO: 15 to 20 days annually, plus standard holidays; additional days for catastrophe deployment may apply
• Common Perks: Continuing education reimbursement for license maintenance and professional designations; potential for hybrid or remote arrangements

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Employment is contingent on successful completion of a background check, which may include verification of prior claims handling history and applicable licensing records. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected by federal, state, or local law. Reasonable accommodations are available to applicants and employees with disabilities throughout the hiring and employment process upon request. Candidates must be authorized to work in the United States.

The Claims Supervisor leads a team of four to six auto adjusters handling mono-line auto and frequency claims, owning coverage determinations, reserve adequacy, and recovery opportunities, including salvage and subrogation. Reporting to claims leadership, the Claims Supervisor also communicates with actuarial and underwriting on litigation trends and develops the department training plans that keep commercial claim outcomes within authority levels.

Key Responsibilities

• Collaborate with claims leadership to shape future department strategy.
• Communicate with claims leadership, actuary, and underwriting regarding litigation, individual claims, best practices, and trends.
• Develop team expertise and training in claim handling procedures in accordance with best practices.
• Recruit and retain team members to the claims organization.
• Manage team inventory of commercial claims including auto physical damage, third party property damage, and bodily injury claims in and out of litigation.
• Ensure the team conducts thorough investigations to determine coverage and liability.
• Ensure proper reserves are set for exposures to the company.
• Ensure appropriate evaluation, negotiation, and settlement of property damage and bodily injuries within authority levels.
• Identify and pursue recovery opportunities including salvage and subrogation.
• Research industry trends and stay apprised of laws in federal, state, and local jurisdictions.
• Develop and conduct department-specific training.
• Serve as a point of contact and knowledge source for all internal departments and clients.
• Ensure the claims team maintains a high level of customer service.

Required Qualifications

• Bachelor's degree or 10 years of relevant claims experience.
• Insurance-related designation such as AIC, SCLA, or CPCU preferred.
• Possession of, or ability to obtain, adjuster licenses in multiple required states.
• Minimum 10 years of experience handling automobile liability for a carrier.
• 3 years of experience in a management role preferred.
• Experience managing litigated claims.
• Strong technical skills in claims functions and business operations.
• Strong communication, collaboration, and teamwork skills.

Embedded within the claims unit, the Claims Supervisor owns the workflow assignment, unit standards, and budget monitoring that keep all claims processing accurate and on schedule. Working closely with other departments and training coordinators, the Claims Supervisor drives the process development and staff communication practices that sustain measurable operational performance.

Core Functions

• Plan, organize, prioritize, and monitor workflow in the unit.
• Assign, distribute, and monitor work to ensure accurate and timely processing of all claims.
• Assist in the development of processes and procedures.
• Develop, maintain, and monitor unit standards to ensure efficient, accurate, and measurable processing.
• Assist in the development of the unit budget and monitor expenses to ensure costs remain within established levels.
• Coordinate training to ensure all staff receive appropriate information and instruction.
• Ensure effective communications are maintained within the unit and externally.
• Coordinate with other units and departments to facilitate special requests and resolve workflow or production issues.

Qualifications & Experience

• Bachelor's degree in a related field or equivalent experience.
• Minimum 2 years of leadership experience in a business-related environment.
• Demonstrated ability to analyze work processes and make recommendations to improve department efficiency.
• Thorough understanding of internal work processes and procedures, with the ability to communicate them effectively to staff and senior management.
• Strong organizational skills.
• Ability to communicate information effectively to a wide variety of technical and non-technical individuals or groups.
• Excellent written and verbal communication skills.
• Regularly exercises discretion and independent judgment in the performance of job duties.

Reporting to claims management, the Claims Supervisor delivers resolution of difficult and complex mechanical claim situations while maintaining department performance objectives, service levels, and continuous improvement recommendations. Partnering with analysts, field representatives, and dealer and customer teams, the Claims Supervisor ensures coaching, escalation support, and KPI evaluation enable consistent operational progress.

Primary Duties

• Provide leadership and development opportunities for associates.
• Ensure feedback, coaching, and development are provided to associates on an ongoing and regular basis.
• Support operational impacts related to mechanical claims evolution with technology and communication preferences of dealers and customers.
• Continuously evaluate key performance indicators and associate-related reporting tools to identify opportunities for process improvement.
• Maintain processes, procedures, and reporting to ensure efficiency and achievement of department performance objectives and service levels.
• Ensure department impacts are known and communicated with teams.
• Work on special projects related to key initiatives and process improvements.
• Serve as point of contact for escalations and claim disputes and provide customer support and resolution.

Skills & Qualifications

• High school diploma or GED required, Bachelor's degree a plus.
• ASE Certifications or OEM Certified preferred, ASE Master a plus.
• 5 or more years of experience in the automotive industry preferred.
• Proficient in Microsoft Office Suite including Excel, PowerPoint, Word, and Teams.
• Experience leading groups through change using proven change management processes.
• Demonstrated leadership skills and experience, preferably in a virtual environment.
• Strong analytical, critical thinking, and presentation skills.
• Proven ability to multitask and manage multiple tasks while driving results.
• Experience with contact center management platforms is a plus.
• Ability to work collaboratively across levels within the organization.

Sitting at the intersection of claims authority and risk governance, the Claims Supervisor shapes decisions on reserves, settlements, reservation of rights letters, and major loss reports above analyst authority thresholds. Operating across a global property casualty environment spanning more than 80 countries, the Claims Supervisor mentors analysts, maintains relationships with underwriters, brokers, and insureds, and promotes a culture of integrity through monthly open file reviews and annual performance cycles.

Duties

• Monitor and provide instructions to analysts.
• Approve reserves and settlements above analyst authority levels.
• Review and approve all reservation of rights and denial letters.
• Review and approve major loss reports.
• Perform monthly open file reviews to ensure compliance with operational and best practices guidelines.
• Ensure analysts coordinate and collaborate with independent adjusters and defense counsel to develop the most efficient, equitable, and timely resolution.
• Ensure analysts provide exceptional customer service.
• Maintain good rapport and close working relationships with underwriters, brokers, and insureds.
• Complete annual performance reviews including mid-year check-in conversations.
• Mentor analysts for future development.
• Promote a culture of integrity and risk management within the team.

Experience & Qualifications

• College degree or equivalent industry experience.
• Claim designations such as AIC or AINS.
• Claim adjuster licenses required.
• Minimum 5 years of experience supervising litigated and non-litigated commercial casualty claims.
• Proficient computer skills including Windows, MS Word, and Excel.
• Strong leadership skills with ability to make decisions and provide direction.
• Excellent organizational, interpersonal, and oral and written communication skills.
• Ability to multi-task and work effectively in a team environment.
• Ability to work independently with minimal supervision.

A key member of the branch leadership team, the Claims Supervisor builds the technical capability and operational discipline of a nationwide remote group of auto adjusters by executing claims strategies across quality, customer service, and performance objectives. Collaborating across coverage analysis, investigation, and damage assessment functions, the Claims Supervisor develops staff through consistent feedback and works within broad authority on complex assignments requiring specialized knowledge.

Accountabilities

• Lead a team of claims adjusters handling auto claims nationwide on a remote basis.
• Execute claims strategies to achieve claims quality, customer service, and operational objectives.
• Manage, develop, and provide technical direction to claims staff.
• Coordinate and provide training on coverage analysis, investigation, damage assessment, and other relevant claims functions.
• Support the strategy and operations of branch claims.
• Provide consistent and meaningful feedback to team members to support their development.
• Work on complex assignments requiring specialized knowledge within broad limits and authority.

Position Requirements

• Four-year college degree or equivalent experience.
• Insurance designation such as AIC, SCLA, or CPCU a plus.
• Licensed claims adjuster with multi-state experience.
• 2 or more years of claims leadership experience with significant personal lines property damage or bodily injury claims experience.
• Formal experience performance managing, developing, and leading a team of adjusters in the insurance space.
• Broad knowledge of claims processes and estimating systems.
• Proficient in Microsoft Office Suite with emphasis on Word and Excel.
• Experience leading remote teams.
• Proven ability to drive results and identify data-supported solutions.
• Strong people management and problem-solving skills.
• Ability to travel when needed.

Accurate and timely adjudication of health care claims on behalf of employer plans and their members depends on the Claims Supervisor, who owns turnaround time monitoring, high-dollar claim release authority, and service level agreement compliance across a team of claim examiners and support roles. Based within a third-party administrator environment, the Claims Supervisor sets and tracks productivity and quality metrics while managing escalated carrier inquiries and sustaining client communication across internal and external channels.

Functions

• Monitor turnaround time and quality for claims processing teams and reprioritize or retrain resources to meet service level agreements.
• Develop, implement, and coordinate programs and training to improve efficiency and performance.
• Provide input into the prioritization of projects within the organization.
• Handle escalated carrier inquiries, department inquiries, and complex claim issues.
• Provide ongoing coaching and development opportunities to direct and indirect reports.
• Identify system workflow requirements to enhance team efficiency.
• Release high-dollar claims.
• Manage inventory of work assigned and work with management to mitigate aging or escalated issues.
• Assist team with inventory when needed.
• Participate in internal and external client communications.

Minimum Qualifications

• 3 or more years of experience with health care plans and processing in a TPA environment.
• Minimum 1 year of prior supervisory experience preferred.
• Proficient in MS Word, Excel, Outlook, and PowerPoint.
• Strong organizational skills.
• Excellent written and verbal communication skills.
• Ability to work from home while overseeing a remote team.

As the Claims Supervisor, this role shapes the Workers' Compensation training program by mentoring examiner trainees, directing all reported claims within established authority levels, and approving reserves and payments that meet reserve adequacy standards for each unit claim. The claims operation relies on this work to develop a pipeline of technically proficient examiners whose handling results and customer outcomes align with the organization's core competencies and performance expectations.

Leadership Responsibilities

• Assist in the preparation and delivery of the Workers' Compensation education and training program.
• Mentor candidates selected for the training program and act in the capacity of an education administrator.
• Train employees in work procedures and company policies.
• Plan, prepare, and revise work schedules and duty assignments according to customer needs, workloads, statistical forecasts, and budget allotments.
• Verify completeness and accuracy of subordinates' work, computations, and records.
• Conduct periodic audits of operations.
• Establish and maintain the company's philosophy and technical practices throughout the claims operation.
• Direct and control all reported claims within the authority level established by the manager.
• Approve reserves and payments within designated authority limits and submit recommendations for those that exceed authority.
• Evaluate team members' job performance and conformance to regulations and recommend appropriate personnel action.
• Interview, select, and discharge employees after consultation with Human Resources.
• Consult with management and other personnel to resolve problems related to employee performance, output quality, and work schedules.

Education & Experience

• High school diploma or GED required, Bachelor's degree preferred.
• IEA Certificate or WCCP Accreditation preferred.
• Minimum 4 to 6 years of claims examining experience.
• Strong understanding of Workers' Compensation claims principles and application.
• Training or adult education experience a plus.
• Strong foundation of business acumen and basic understanding of personnel and performance strategies.
• Excellent verbal and written communication, time management, and organizational skills.
• High level of attention to detail and ability to present information effectively to senior management and public groups.
• Team-oriented with a sense of urgency for execution.

Legal Claims Supervisor leads high-volume medical and legal document review teams supporting large-scale class action litigation, managing reviewer productivity, workflow quality, and client deliverable timelines across active cases. The work directly supports internal teams spanning client relations, sales, operations, and IT, with the Legal Claims Supervisor accountable for defining review processes, maintaining confidential client databases, and coordinating knowledge dissemination through leads and trainers.

Scope of Work

• Oversee the process of high-volume medical and legal document review in support of litigation.
• Coordinate with internal teams and leaders across client relations, sales, operations, and IT to establish and meet client and project deliverables.
• Work with leads and trainers to provide and disseminate new or case-specific knowledge.
• Provide refresher training, coaching, and guidance as needed.
• Manage workflow of the team through internal systems and third-party vendor portals and applications.
• Document and report production, events, communications, and project development according to standard operating procedures.
• Maintain a database of confidential client information with integrity.
• Identify inefficiencies and areas for improvement.
• Define processes and procedures for review teams, adhering to overall company policies and requirements.

Background & Experience

• 3 or more years of experience in a supervisory role.
• Large-scale document management experience.
• Knowledge of medical claims and legal case review.
• Knowledge of litigation, large-scale civil action lawsuits, mass torts, or similar procedures preferred.
• Experience with MS Office Suite, including the ability to run PivotTables and V-lookups.
• Strong leadership, communication, and organizational skills.
• Analytical skills and ability to identify areas for improvement.
• Results-driven with the ability to make adjustments and achieve outcomes.
• Ability to work independently while coordinating with management, internal teams, and direct reports.

The Regional Claims Supervisor oversees claim outcomes for self-insured and unbundled liability clients by managing reserve and settlement authority, directing diary management, and analyzing portfolio trends at the adjuster, unit, and account levels. Reporting to claims management, the Regional Claims Supervisor administers personnel programs, manages the litigation process with counsel, and develops claims professionals for promotional opportunities while sustaining customer service across account management and claims reviews.

Key Responsibilities

• Manage the assignment of claims and provide technical direction and ongoing guidance through effective diary management.
• Select, train, coach, and mentor staff, directing activities to meet department goals in accordance with approved plans and budgets.
• Ensure appropriate claim reserves are established and communicated in a timely manner.
• Manage reserve and settlement authority on the claims unit's pending inventory.
• Recognize and analyze trends across the claims portfolio at the adjuster, unit, and account levels, and develop action plans to address areas of opportunity.
• Administer salary and personnel programs for the unit.
• Participate in quality assurance programs and develop training agendas based on performance data.
• Provide a superior level of customer service and participate in the account management process, including marketing calls and claims reviews.
• Manage the litigation process and participate in counsel evaluation with claims management and the client.
• Collaborate with internal and external business partners to ensure program details are developed and communicated to the team.

Professional Experience

• Bachelor's degree required.
• State adjusting licenses obtained and maintained as required, including all state-required Continuing Education Credits.
• Minimum of 7 years of progressively responsible experience in handling General Liability, Automobile, Professional Liability, and Property claims.
• Working knowledge of MS Office including Word, Excel, and PowerPoint.
• Previous supervisory experience and professional designation desired.
• Proven leadership, coaching, and teamwork skills.
• Excellent verbal and written communication skills, including ability to lead or participate in meetings, presentations, and conferences.
• Excellent customer service skills with emphasis on accessibility, listening, and responsiveness.

Embedded within the LTC claims unit, the Claims Supervisor develops a team of six to eight long-term care claim adjusters through attainable performance goals, real-time coaching, and disciplinary processes that uphold department and company standards. Working closely with human resources and senior management, the Claims Supervisor drives continuous workflow improvement, maintains detailed personnel documentation, and builds a high-performance culture through structured hiring and trend analysis.

Day-to-Day Responsibilities

• Set and clearly communicate goals for team members to ensure department and company standards are met.
• Ensure team reviews all workflows on an ongoing basis to capitalize on effectiveness.
• Ensure all team members are fully trained and utilizing appropriate technology.
• Provide day-to-day leadership, coaching, and counseling to assigned staff.
• Monitor assigned staff and provide real-time feedback.
• Guide the team in identifying root causes of unfavorable trends and implementing solutions.
• Manage personnel issues consistently and in accordance with department policies.
• Administer performance management steps and disciplinary action on a timely basis consistent with company policy.
• Develop detailed documentation and ensure all records are maintained in each employee's file.
• Conduct interviews and participate in the hiring process to build a high-performance culture.

Knowledge, Skills & Abilities

• Two-year college degree (A.A.) preferred.
• Minimum 5 years of long-term care claims experience or equivalent.
• Recent supervisory or management experience preferred, with emphasis on performance management.
• Proficient in Microsoft Office and other applicable computer systems, with advanced Excel experience preferred.
• Proficiency in oral and written English language communication.
• Demonstrated ability to work cooperatively with others.
• Well-organized and highly detail-oriented.
• Able to manage multiple tasks and projects under time constraints.

Reporting to the RLDM Director, the Claims Supervisor advances compliance and operational performance across REO asset management, agency and MI claims, and vendor oversight by managing staff productivity and daily default team functions in accordance with state, federal, investor, insurer, and agency requirements. Partnering with cash and investor accounting departments, the Claims Supervisor refines business practices within default management and oversees post-sales activity on bank-owned, FHA, FNMA, FHLMC, and private MI files.

Ownership Areas

• Manage the training and development of staff in accordance with state and federal laws and compliance with investor, insurer, agency, and company guidelines.
• Develop and maintain current policies and procedures to meet agency and organizational guidelines.
• Complete performance management activities including delivering and monitoring relevant, achievable, and measurable action plans.
• Ensure all training programs, compliance and regulatory certifications, and development courses are completed as scheduled.
• Develop and maintain business relationships with internal and external vendors and borrowers.
• Assist with internal and external audits.
• Review existing business practices within default management for efficiency, effectiveness, and compliance with required regulations and requirements.
• Maintain knowledge of agency claims processes such as FHA, FNMA, FHLMC, and Private MI.
• Oversee all post-sales activity on bank-owned, agency, and MI files, including filing conveyances and claims for outstanding advances on liquidated loans.
• Partner with cash and investor accounting departments to manage accurate claims processing, recovery, and accounting.
• Oversee all aspects of property preservation and REO asset management, including eviction, title review, tenant leases, market analysis, vendor management, repairs, closings, and reporting.

Technical Qualifications

• Finance or business degree preferred.
• 3 to 5 years of management or supervisory experience, preferably in consumer and real estate lending, small business, or merchant servicing.
• Comprehensive knowledge of the specifically assigned area.
• Proficiency in PC and computer systems preferred.
• Excellent oral and written communication and organizational skills.

Sitting at the intersection of property coverage authority and fraud oversight, the Claims Supervisor produces accurate claim outcomes for homeowner lines across multiple states by directing desk adjusters, interpreting policy provisions, and approving settlements that exceed staff authority levels in compliance with Unfair Practices Act requirements. Operating across catastrophic event response, vendor management, and Department of Banking and Insurance complaint handling, the Claims Supervisor applies homeowner product knowledge and damage estimating expertise to every coverage and liability determination.

Job Functions

• Direct and control the work of desk adjusters and establish unit goals for service, production, and work quality.
• Monitor assignment of claims to unit members based on complexity, severity, and volume.
• Supervise all aspects of claim investigation and damage handling.
• Interpret expert reports to make final determinations on proximate cause, negligence, and damages.
• Interpret policy provisions to determine coverage or applicable exclusions.
• Respond to Department of Banking and Insurance complaints.
• Review, assess, and identify fraud and breach of policy conditions, providing direction on how to proceed.
• Monitor and manage fraud initiatives across the claims operation and determine the company's exposure.
• Investigate and initiate subrogation when applicable.
• Provide oversight of reserve adjustments for homeowner lines of business.
• Participate in catastrophic claim handling, including travel to other locations and extended hours as needed.
• Oversee the unit's vendor management program.
• Evaluate team member performance and conduct mid-year and annual performance reviews.
• Conduct training on a group and individual basis on all aspects of the job.

Requirements

• Bachelor's degree required.
• 5 or more years of related experience, including homeowner claims or prior supervisory experience in claims.
• Claims litigation handling, training, and supervisory background preferred.
• Experience with claims management systems and the Microsoft Office Suite.
• Experience with damage estimating systems and management reporting tools beneficial.
• Strong organizational, verbal, and written skills.
• Ability to function professionally in high-volume or adversarial situations.

A key member of the claims QA unit, the Claims Supervisor develops the audit plans, monthly file review schedules, and results reports that give claims leadership a measurable picture of file handling compliance and process gaps across departmental and focused audit types. Collaborating across compliance auditors, training teams, and claims leadership, the Claims Supervisor administers data controls in claims software systems, leads follow-up audits to verify deficiency correction, and serves as a technical resource to QA staff and the broader claims organization.

Role Responsibilities

• Review completed file audits processed by the quality assurance team.
• Develop and complete monthly and quarterly results reports.
• Complete complex targeted audits and related reporting.
• Develop training materials based on audit results and collaborate with the training team to update materials.
• Conduct claims file audits to ensure file handling follows industry best practices.
• Plan each audit including date range and audit scope, and communicate scope to appropriate parties.
• Advise appropriate parties of current audit results while recognizing and communicating trends, training needs, and compliance requirements.
• Perform wrap-up meetings identifying follow-up activity such as training, compliance, and process review requirements.
• Complete follow-up audits to determine whether deficiencies are corrected.
• Maintain quality metrics and scorecards.
• Identify process gaps and provide recommendations to claims leadership.
• Lead the claims QA unit and provide direction as required.

Education & Experience

• High school diploma required, 4-year college degree preferred.
• Minimum 10 years of claims handling experience, preferably with a strong focus in bodily injury and material damage handling.
• Solid understanding of claims best practices and applicable statutes, regulations, and case law.
• Proficient in MS Excel and Word.
• Business results focused with capability for strategic-level responsibilities.
• Exceptional attention to detail.
• Strong collaborative orientation with the ability to build relationships across the organization.
• Ability to multi-task in a fast-paced environment while meeting critical deadlines.
• Willingness to be flexible and mobile for career advancement.

Consistent adjudication of high-dollar and complex claims across a managed care environment depends on the Claims Supervisor, who refines the policies, procedures, and staff monitoring practices that sustain established claims service standards while supervising day-to-day examiner operations. Serving as a resource to claims examiners, customer service, vendor partners, and organizational development specialists, the Claims Supervisor recruits and evaluates staff using an equity, diversity, and inclusion approach and maintains payment integrity activities that protect member and plan outcomes.

Performance Expectations

• Coordinate and supervise the day-to-day operations of a claims team.
• Maintain and enhance production statistics including turnaround time, claims resolution, and adjudication of claims.
• Perform ongoing analysis of data and information to identify opportunities to improve operational efficiency in claims processing and payment integrity.
• Analyze claims reports and report findings to claims management.
• Develop effective policies, procedures, objectives, and staff monitoring practices to ensure the department consistently achieves established claims service standards.
• Ensure the claims team effectively collaborates with other departments and business partners.
• Act as a resource to claims examiners, customer service, and other departments.
• Stay current with changes and advancements in claims processing and service.
• Collaborate with organizational development, claims auditors, and claims trainers to develop and implement training programs for claims examiners.
• Create and update documentation and resource materials as needed.
• Support vendor partnerships related to claim payment integrity activities.
• Supervise team and recommend team direction and goals in alignment with the organizational mission and values.
• Identify work and staffing needs, recruit and hire using an equity, diversity, and inclusion approach.
• Evaluate employee performance and provide regular feedback, addressing performance gaps through corrective action as needed.

Experience & Qualifications

• Experience in claims processing systems and reports, with the ability to manage department and individual performance.
• Understanding of principles of organizational change and ability to act as a change agent.
• Working knowledge of basic concepts of managed care.
• Excellent data analysis and mathematical skills.
• Excellent reading comprehension, oral and written communication skills.
• Proficient in Microsoft Outlook, Word, and Excel.
• Strong problem-solving, decision-making, negotiation, and consensus-building skills.
• Ability to manage multiple tasks, complex projects, and delegate appropriately.
• Ability to work well under pressure in a complex and rapidly changing environment.
• Ability to supervise a diverse workforce, develop work plans, and maintain appropriate claims adjudication service levels.
• Ability to mentor individual growth and serve as a positive and influential role model.
• Strong interpersonal and customer service skills.