Role Description
We are seeking an experienced and motivated Supervisor to lead our Plan Building and System Configuration team, ensuring accurate, efficient, and compliant plan setup and claims adjudication across multiple systems. This role combines hands-on technical expertise with leadership responsibility, overseeing daily operations, mentoring team members, and driving continuous improvement in system performance and process efficiency.
Primary Responsibilities:
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Leadership and Team Management:
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Supervise the Plan Building and System Configuration team, providing coaching, performance feedback, and professional development.
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Prioritize and assign work to ensure timely completion of configuration and testing deliverables.
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Monitor productivity and quality standards, taking proactive steps to address performance or process issues.
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Foster collaboration and a culture of accountability, innovation, and continuous improvement.
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Plan Building and Configuration:
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Oversee the design, configuration, and maintenance of healthcare plan setups in multiple systems to support accurate auto adjudication.
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Review and approve team configurations to ensure compliance with benefit specifications and regulatory requirements.
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Serve as an escalation point for complex or high-impact configuration issues.
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System Integration and Management:
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Coordinate with IT and other operational teams to manage system integrations, upgrades, and enhancements.
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Lead efforts to identify and implement process and technology improvements to streamline auto adjudication.
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Ensure system stability and alignment with organizational goals and compliance standards.
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Claims Testing and Quality Assurance:
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Direct and oversee testing efforts for new and updated configurations.
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Establish and maintain testing protocols and quality standards to ensure claims process accuracy.
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Analyze error trends and system performance data to drive corrective actions and process optimization.
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Stakeholder Collaboration:
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Partner with internal departments and external clients to gather requirements and validate plan configurations.
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Act as a subject matter expert (SME) for plan building and configuration, providing guidance across departments.
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Communicate project progress, risks, and resolutions effectively to stakeholders and leadership.
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Reporting and Documentation:
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Ensure complete and accurate documentation of all plan configurations, testing procedures, and system changes.
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Utilize reporting tools and analytics to monitor performance, identify improvement opportunities, and inform decision-making.
Qualifications
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Associate’s degree in healthcare administration, information systems, or a related field (Bachelor’s preferred).
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Minimum of 3-5 years of experience in plan building, system configuration, and claims adjudication in the healthcare industry.
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Minimum of 1–2 years in a lead or supervisory capacity.
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Strong understanding of healthcare benefit administration, auto adjudication processes, and regulatory compliance.
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Proven ability to lead teams, manage priorities, and deliver results in a fast-paced environment.
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Excellent communication, analytical, and problem-solving skills.
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Proficiency in healthcare management systems and configuration tools.
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Ability to work in a fast-paced environment and manage multiple projects simultaneously.
Preferred Qualifications
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Experience with auto adjudication systems and technologies.
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Certification in healthcare information systems or related fields.
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Proven track record of successful system integration and optimization projects.
Benefits
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Comprehensive medical, dental, vision, and life insurance coverage.
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401(k) retirement plan with employer match.
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Health Savings Account (HSA) & Flexible Spending Accounts (FSAs).
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Paid time off (PTO) and disability leave.
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Employee Assistance Program (EAP).
Pay Transparency
$70,000 — $85,000 USD
Equal Employment Opportunity
At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
