Job Title: Claims Supervisor
Job Type: FT
Location: #LI- Remote, to be considered for this role, you must reside in one of the following states — AL, AK, AR, AZ, CT, DE, FL, GA, IA, ID, IN, KS, KY, LA, ME, MI, MT, MS, MO, NC, ND, NE, NH, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WI, WV, WY
Job Summary
We are passionate about our clients having a great experience and this also applies to our team and our future team members. Building a remarkable team is a top-level company priority. The Claims Supervisor is responsible for overseeing the day-to-day operations of the claims processing function, ensuring timely, accurate, and compliant adjudication of all participant claims. This role leads a team of Reimbursement Specialists and is accountable for production performance, quality standards, and turnaround times. In addition to internal team leadership, this role oversees and partners with outsourced claims processing vendor, ensuring alignment to service level agreements (SLAs), quality expectations, and operational standards. The Claims Supervisor plays a key role in driving operational performance through reporting, analytics, and continuous improvement, while maintaining strict adherence to IRS and regulatory requirements. This position reports to the Customer Service Manager.
What You’ll Do
Team Leadership & Development
- Lead, coach, and develop a team of Reimbursement Specialists, ensuring strong performance, accountability, and engagement.
- Conduct regular 1:1s, team meetings, and performance reviews aligned to production, quality, and compliance expectations.
- Support hiring, onboarding, and ongoing training to ensure team readiness and consistency in adjudication practices.
- Foster a culture of accountability, accuracy, and continuous improvement.
Claims Operations Oversight
- Oversee daily claims processing activities to ensure adherence to turnaround time (TAT) and productivity standards.
- Monitor workload distribution, backlog levels, and processing queues to maintain operational efficiency.
- Act as an escalation point for complex claims and adjudication decisions.
- Ensure consistent application of plan rules, documentation requirements, and IRS guidelines.
Vendor Management & Oversight
- Manage and oversee outsourced claims processing vendors, ensuring alignment with internal standards and contractual SLAs.
- Monitor vendor performance across quality, productivity, and turnaround time metrics.
- Partner with vendors to address performance gaps, provide feedback, and drive continuous improvement.
- Ensure clear communication, accountability, and operational consistency between internal and external teams.
Performance Management & Reporting
- Monitor and report on key metrics including claims TAT, accuracy, productivity, backlog, and quality scores.
- Develop and deliver daily, weekly, and monthly reporting to leadership, highlighting performance trends, risks, and opportunities.
- Utilize strong Excel and analytical skills to interpret data and drive informed decision-making.
- Identify trends and implement corrective actions to improve performance and reduce errors.
Quality Assurance & Compliance
- Ensure all claims are adjudicated in accordance with IRS regulations, plan documents, and internal policies.
- Conduct audits, identify trends, and provide targeted coaching.
- Reinforce documentation standards, substantiation requirements, and fraud awareness protocols.
- Maintain a high standard of accuracy and compliance across all processing activities.
Process Improvement & Operational Excellence
- Identify and implement process improvements to increase efficiency, reduce rework, and enhance quality.
- Partner with cross-functional teams to resolve systemic issues and improve workflows.
- Support transition initiatives, including process changes, system updates, and vendor integrations.
- Perform other duties as assigned.
Who You Are
- 3–5 years of experience in claims processing or reimbursement operations, preferably within benefits administration or healthcare.
- Prior experience in a supervisory or team lead role, with demonstrated ability to lead and develop teams.
- Strong understanding of claims adjudication, IRS regulations, and substantiation requirements.
- Experience working with or managing outsourced vendors or offshore teams.
- Proven ability to manage performance against key metrics including TAT, accuracy, and productivity.
- Advanced proficiency in Excel and reporting, with strong analytical and problem-solving skills.
- Experience working with claims platforms and/or CRM systems (e.g., Alegeus or similar).
- Detail-oriented with a strong focus on accuracy, compliance, and process consistency.
- Effective communicator with the ability to drive accountability and influence outcomes.
- Ability to operate in a fast-paced environment and manage multiple priorities effectively.
- Someone with strong interpersonal skills who understands that our business objective is to provide superior customer service and can handle conflict in a professional manner.
Work Environment
FloresHR’s standard work hours are Monday through Friday, 8:30 a.m. to 5 p.m. ET with an hour lunch. Roles may be approved for other schedules by managers. This role operates in a professional #LI-remote office environment. To be considered for this role, you must reside in one of the following states — AL, AK, AR, AZ, CT, DE, FL, GA, IA, ID, IN, KS, KY, LA, ME, MI, MT, MS, MO, NC, ND, NE, NH, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WI, WV, WY. This role is mostly sedentary and consists of prolonged periods sitting at a desk and working on a computer. This role also utilizes other tools such as a phone, copy machine, and printer. Common programs often used are Outlook, Word, and Excel. This position frequently communicates with FloresHR team members and candidates and must be able to exchange accurate information clearly in these situations.
How We Support Our Team
At FloresHR, we invest in our people, our community and our technology and strive to provide work life balance, paired with professional growth for each of our employees. We provide an innovative benefit solution for our clients but that does not apply just to our clients. They extend to our team too!
- Competitive Benefits – FloresHR offers competitive medical, dental, and vision benefits for employees and their families. We also provide company funded HSA’s, Pre- and Post-tax 401k’s with a company match up to 5%, and other great benefits such as Life Insurance, Accident Insurance, Pet insurance, and more!
- Work Life Balance – We want all our team members to have time to focus on themselves and their families. We offer a Monday - Friday schedule, a generous vacation policy and a Life Balance Reimbursement Plan to support this.
- Community Involvement – We love to give back to our community, and we recognize that our team does too! We have a volunteer program in place to support our team members as they help the organizations’ they are passionate about.
Our Core Values & Diversity Focus
Our vision is to be the most admired benefits partner, and our core values and beliefs are:
- We believe in always doing the right thing.
- We believe that a remarkable service experience is possible.
- We believe in trusting one another as an operating philosophy.
- We believe that high performance teams deliver extraordinary results.
- We believe in building benefits technology that converts the complex to easy.
- We seek to empower, empathize, and respect our team members and our world.
FloresHR is proud to be an Equal Employment Opportunity employer. We do not discriminate based on race, color, creed, ancestry, national origin, citizenship, sex or gender (including pregnancy, childbirth, and pregnancy-related conditions), gender identity or expression (including transgender status), sexual orientation, marital status, religion, age, disability, genetic information, service in the military, or any other characteristic protected by applicable federal, state, or local laws and ordinances. We are committed to diversity and are committed to creating an inclusive environment for all employees. This is not intended to be an all-inclusive list of job related responsibilities and requirements.
