National Vision Administrators is seeking an experienced Claims Supervisor to lead the daily operations of our claims team in vision benefit plans. This role is responsible for ensuring accurate and timely processing of Medicare and Medicaid claims, while maintaining compliance with regulatory requirements and internal quality standards.
The ideal candidate brings strong claims adjudication expertise, leadership experience, and deep knowledge of medical billing and coding practices, with the ability to support team development and operational excellence.
Key ResponsibilitiesTeam Leadership & Operations
- Supervise and support a team of claims processors, ensuring productivity and accuracy goals are met
- Manage daily workflow, prioritization, and workload distribution
- Provide coaching, training, and performance feedback to team members
- Serve as a point of escalation for complex or high-priority issues
Claims Processing & Adjudication
- Review and approve complex, high-dollar, and escalated claims
- Ensure accurate adjudication of Medicare and Medicaid claims
- Oversee resolution of denied, rejected, and pended claims
Billing, Coding & Compliance
- Ensure proper application of CPT, ICD-10, HCPCS codes, and modifiers
- Maintain compliance with Prompt Pay regulations and all applicable billing guidelines
- Monitor adherence to CMS requirements and internal policies
- Support internal and external audits as needed
COB/TPL & Issue Resolution
- Oversee coordination of benefits (COB) and third-party liability (TPL) claims processing
- Investigate and resolve billing discrepancies and claim denials
- Ensure timely follow-up on resubmissions, appeals, and remittance issues
Reporting & Systems
- Monitor team performance metrics and quality outcomes
- Utilize systems such as ManageEngine and claims platforms (e.g., AS400 or similar) to track tickets, escalations, and workflow
- Support reporting and quality assurance initiatives
Qualifications
Required:
- 5+ years of experience in vision or healthcare claims processing and adjudication
- 1+ year of leadership, supervisory, or team lead experience
- Strong knowledge of:
- Medicare and/or Medicaid claims processing
- CPT, ICD-10, HCPCS coding and modifiers
- CMS-1500 (HCFA) forms and electronic billing
- Claims lifecycle (timely filing, denials, appeals, resubmissions, remittance)
- Experience resolving denied/rejected claims and handling escalations
- Proficiency in Microsoft Excel and Office Suite
- Strong communication, organization, and problem-solving skills
Preferred:
- Experience with coordination of benefits (COB) and third-party liability (TPL) claims
- Familiarity with AS400 or other healthcare claims processing systems
- Experience in vision care, optometry, ophthalmology, or related specialties
- CPC, CPB, or CBC certification
What We’re Looking For
- A hands-on leader who can balance team management with operational execution
- Strong attention to detail and commitment to accuracy and compliance
- Ability to work in a fast-paced, deadline-driven environment
- A proactive problem-solver who can identify issues and implement solutions
Pay: $70,000.00 - $80,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Vision insurance
Work Location: In person
