Healthcare Claims Supervisor

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    "id": "480",
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    "jobOpeningName": "Healthcare Claims Supervisor",
    "departmentLabel": "Claims Adjudication",
    "employmentStatusLabel": "Full-Time"
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    "location": {
      "city": "Makati",
      "state": "Metro Manila",
      "postalCode": "1227",
      "addressCountry": "Philippines"
    },
    "datePosted": "2026-05-08",
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    "description": "<p><span style=\"color: rgb(186, 55, 42); font-family: arial, helvetica, sans-serif; font-size: 18pt; font-weight: bold\"><span style=\"font-family: arial, helvetica, sans-serif\"><span style=\"font-weight: bold\">Healthcare Claims Supervisor</span></span> (Onsite)</span></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt\"><span style=\"font-weight: bold\">Work Set-Up: Office-based (Onsite)</span></span></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt\"><span style=\"font-weight: bold\">Location:</span> Makati, Valero</span></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt; text-decoration: underline\"><span style=\"font-weight: bold\">Position Summary</span></span><br><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">The Claims Adjudication Supervisor is responsible for leading, developing, and managing the end-to-end medical claims adjudication function for US health plan operations. This role ensures high-quality claims processing, operational accuracy, adherence to KPIs and SLAs, and exceptional client communication.</span></p>\n<p><br><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">The supervisor will be accountable for building and executing comprehensive training programs (curriculum, modules, assessments, certifications), overseeing quality assurance processes, driving team accountability through structured performance management, and providing timely, consistent business reporting to both internal leadership and external clients.</span></p>\n<p><br><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">This is a highly visible, client-facing role requiring strong communication skills, deep knowledge of U.S. healthcare claims adjudication, and the ability to lead teams in a fast-paced environment.</span></p>\n<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt; text-decoration: underline\"><br></span><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt; text-decoration: underline\"><span style=\"font-weight: bold\">Key Responsibilities</span></span></p>\n<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt; font-weight: bold\">Operations &amp; Team Leadership</span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Oversee daily medical claims adjudication operations to ensure accuracy, productivity, and SLA compliance.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Monitor KPIs, quality metrics, and team performance through dashboards, coaching, and regular performance reviews.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Lead escalations, workforce accountability, and continuous improvement initiatives to reduce errors and processing delays.</span></li>\n</ul>\n<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt; font-weight: bold\">Training &amp; Development</span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Own the end-to-end training program, including curriculum development, onboarding, uptraining, certifications, and refresher training.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Develop and maintain SOPs, training materials, assessments, and learning modules.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Track training effectiveness and provide regular progress reporting to leadership and clients.</span></li>\n</ul>\n<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt; font-weight: bold\">Quality Assurance</span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Manage QA processes, audit programs, calibration sessions, and error trend analysis.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Ensure consistency in quality scoring, oversee rebuttal handling, and implement corrective action plans.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Provide QA insights, root-cause analysis, and performance recommendations.</span></li>\n</ul>\n<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt; font-weight: bold\">Client Communication &amp; Reporting</span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Serve as the primary operational contact for client communications and escalations.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Deliver timely business reviews and reports covering productivity, quality, SLA performance, and improvement initiatives.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Maintain consistent and professional communication with internal and external stakeholders.</span></li>\n</ul>\n<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt; font-weight: bold\">Compliance &amp; Cross-Functional Collaboration</span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Ensure compliance with operational standards, client requirements, and regulatory guidelines.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Partner with HR, QA, Training, Workforce Management, and Client Services teams to support operational goals and execution.</span></li>\n</ul>\n<p><br><br></p>\n<p><span style=\"text-decoration: underline\"><span style=\"color: rgb(0, 0, 0); font-size: 12pt; font-weight: bold; text-decoration: underline\">Qualifications</span></span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">5+ years of experience in U.S. healthcare claims adjudication, with deep end-to-end process knowledge.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">2–3 years of leadership experience managing claims adjudication teams (35-50 FTEs). </span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Strong understanding of medical terminology, coding (ICD, CPT, HCPCS), plan structures, and benefit rules.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Excellent verbal and written communication skills; highly responsive and professional with clients.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Demonstrated ability to create training programs, curriculum, modules, and certification paths.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Experience managing KPIs and SLAs in a BPO or healthcare operations environment.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Strong analytical and problem-solving abilities; comfortable with data-driven decision-making.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Ability to work in a fast-paced environment and manage multiple priorities.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Experience supporting U.S. health plans or TPAs.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Exposure to AI-assisted adjudication tools or digital transformation initiatives.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Background in quality assurance or instructional design.</span></li>\n</ul>\n<p><br><br></p>\n<p><span style=\"text-decoration: underline\"><span style=\"color: rgb(0, 0, 0); font-size: 12pt; font-weight: bold; text-decoration: underline\">Key Competencies</span></span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Operational Excellence – Drives KPIs, SLAs, quality, timelines.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Training &amp; Development – Builds world-class training ecosystems.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Quality Management – Deep expertise in audits, trends, calibrations.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Client Communication – Clear, timely, professional, solutions-oriented.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Leadership – Coaches leaders and frontline staff; builds high-performing teams.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Accountability – Ensures consistent follow-through and ownership.</span><br><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Strategic Thinking – Anticipates risks, proposes improvements, aligns stakeholders.</span></li>\n</ul>\n<p><br><br></p>\n<p><span style=\"text-decoration: underline\"><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold; text-decoration: underline\">Additional Benefits:</span></span><br></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">HMO - Medical &amp; Dental (coverage on Day 1 plus 1 dependent)</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt\">Transportation Allowance<br></span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt\">Equipment will be provided</span><br></li>\n</ul>\n<p><br></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt; text-decoration: underline\"><span style=\"font-weight: bold\">COMPANY OVERVIEW:</span></span></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt\">Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and</span></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt\">satisfaction with plans’ members and providers. </span></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt\">The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.</span></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt\">Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.</span></p>",
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