Working Each Day to Make a Difference

At Community Health Plan of Washington, we're driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

• We are a local not-for-profit health plan in Washington State.
• We are committed to keeping Washington families healthy.
• We connect our communities to the health resources they need.
• We provide access to high-quality care for our members.
• We connect and empower our members through technology.
• The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
• Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org{rel="nofollow"}.

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*Supervisor Claims Investigation and Recovery *

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[POSITION PURPOSE:]{.underline}

Responsible for assisting the Director Claims Integrity by providing leadership for cost recovery and claim investigation, including direct management of staff, cross-departmental coordination, and vendor relationship management.* *

[PRINCIPAL DUTIES:]{.underline}

• Responsible for all aspects of supervision including hiring, performance management, training, assisting with development of direct reports and building a cohesive and supportive work environment.
• Supervise a highly effective team to support daily work activities for CHPW cost recovery and claims investigation.
• Identify and execute process improvements to enhance existing programs.
• Responsible for vendor management for subrogation activities, reclamation and cost avoidance.
• Identify trends in provider inquiries and initiate effective resolution that promotes production efficiency and ensuring staff have the training, tools and resources needed for success.
• Establish processes to effectively manage cross departmental workgroups, ensuring effective communication, issue resolution and decision making.
• Respond to regulatory authority inquiries and complaints.
• Recommend corporate policy (e.g., payment policies) based upon thorough understanding of industry and regulatory standards, contractual requirements, etc.
• Assist in establishing standard process to monitor and report program performance, working across technical and departmental units to define business requirements necessary to support program performance measurement and evaluation activities.
• Explore and utilize opportunities to improve corporate performance in areas involved with claims.
• Participate in and oversee the work involved in audits as needed.
• Direct and monitor work assignments, delegation of projects and timekeeping records for direct reports.
• Establish policies and procedures for the team along with the Director.
• Responsible for disseminating regular reports on departmental activities to interested parties with a focus on integrating suggestions and/or recommendations.

[QUALIFICATIONS:]{.underline}

[Education]{.underline} & [Prior Related Experience]{.underline}:

Have a bachelor's degree or a combination of education and highly relevant experience. Required.