Claims Operations Supervisor (U.S. Healthcare Claims)
Work Set-Up: Office-based (Onsite)
Location: Makati, Valero
We are looking for a Claims Supervisor to lead U.S. healthcare claims operations, with a strong focus on team performance, quality, service levels, stakeholder communication, and continuous improvement. This role is ideal for a people leader with solid experience in healthcare claims, adjudication, or revenue cycle operations who can drive results in a fast-paced, metrics-driven environment.
Key Responsibilities
- Lead daily claims operations to meet accuracy, productivity, quality, and service level goals.
- Manage team performance through coaching, performance monitoring, and issue resolution.
- Partner with training and QA teams to strengthen onboarding, refresher training, accuracy, and consistency.
- Handle client or stakeholder communication, escalations, and operational updates in a timely and professional manner.
- Provide regular business updates on team performance, quality, service levels, and improvement actions.
- Drive continuous improvement initiatives to reduce errors, delays, and rework.
- Ensure adherence to operational processes, controls, and compliance requirements.
- Collaborate with cross-functional teams such as QA, training, workforce management, HR, and client services to support execution.
Must-Have Qualifications
- 4+ years of experience in U.S. healthcare claims processing, adjudication, or revenue cycle management.
- 2+ years of team leadership experience (20-30) Claim Examiners) in healthcare operations, claims, or revenue cycle management.
- Strong understanding of claims workflows, medical terminology, coding concepts, benefits, and payer/provider processes.
- Experience managing productivity, quality, service levels, and team performance in a metric-driven environment.
- Ability to coach team members, manage escalations, and drive issue resolution.
- Strong written and verbal communication skills for client, stakeholder, and internal operations discussions.
- Strong analytical and problem-solving skills.
Preferred Qualifications
- Experience supporting U.S. health plans, TPAs, healthcare BPOs, or shared services operations.
- Exposure to payment review, denials, appeals, or related claims functions.
- Experience supporting training, onboarding, coaching, or capability-building initiatives.
- Exposure to process improvement, automation, or digital transformation initiatives.
- Background in quality assurance, audit, or calibration activities.
Work Setup
Office-based position
Key Competencies
- Operational leadership
- People coaching and performance management
- Quality and service level management
- Client and stakeholder communication
- Analytical thinking and problem-solving
- Continuous improvement and cross-functional collaboration
