Job Description

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.

Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as "Great Places to Work" in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation's Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.

We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.

What You'll Be Doing:

Supervisor, Claims

Position summary

Evolent is looking for bright and energetic individuals to be a Supervisor for Claims team. Candidate should be willing to work in US shift hours.

Roles & Responsibilities

Principal Accountabilities

• Ensures accurate and timely completion of transactions to meet and exceed SLAs
• Identify & resolve both Regular and non-routine problems or escalate to more proficient team members
• Apply knowledge, theoretical concepts to undertake problem solving
• Works on preparation of SOPs / Process Transitions
• Develops tactical and Operational plans to achieve key milestones in the project.
• Be a Subject matter expert

Essential functions - Direction / Planning / Initiatives

• Manage the team, monitor team performance, and monitor operational deliverables for the team.
• Manage relationships between stateside counter parts for smooth performance of the team as well to achieve the company wide goals.
• Coaches, Motivates and guides team members.
• Monitor workload fluctuations and adjust staff assignments accordingly both directly and by coaching.
• Leads team in the achievement of Project milestones and department objectives
• Ensures team is meeting or exceeding service level obligations to the customers.
• Responsible for management and oversight of the Claims Department to ensure timely adjudication of claims/updating members records for health care services, received from contracted and non-contracted providers and to ensure all Federal, State and Client requirements are met timely and efficiently in accordance with regulations and client guidelines.

Knowledge - Technical / Professional

• Applies advanced and demonstrated knowledge of wide range of policies & procedures.
• Deep understanding of Internal Operations & related functional areas to achieve results.
• Develops Best practice processes on work assignments, Project management, Quality of output while maximizing overall team performance.
• Improves Efficiency, Quality and Service of ongoing work.
• Should be having experience of Claim processing, Benefit and Pricing configuration logic.
• Manages a multi-functional unit of claim professionals/Enrolment associates and support staff.

Business

• Leads claims team in support of department initiatives and strategies in cost containment, case file handling, customer service and quality.
• Consistently monitors workflows to maximize accuracy and efficiency. Maintains an acceptable level of service and customer satisfaction and retention.
• Effectively manages the quality review process.
• Develops unit goals, objectives, processes, procedures and systems.
• Stays abreast of changes in health plan benefit and pricing methodologies.
• Collaborates with all to achieve objectives and ensure information flow.

People Management:

• Identifies team staffing needs and takes necessary measures to ensure appropriate levels of service. Mentors employees and develops career paths with growth opportunities.
• Participates in development of annual departmental budget, monitors budget and identifies budget discrepancies. Research cause of discrepancies and makes recommendations.
• Provides input for team members annual performance review.
• Facilitate periodic project tracking to management as needed.
• Validate and ensure departments compliance to company requirements.
• Participates in special projects and serves on committees as needed.

Mandatory Skills

• Should have independently managed a team of at least 15 - 30 people
• Hands on Payer - Claim Processing knowledge
• Functional experience of 8 years and more as a Team Lead / Supervisor /Asst Manager.
• Deep Knowledge on Productivity, Quality Scorecards
• Understanding Audits, Audit requirements and functions
• Functional knowledge on Reports, reporting

Preferred Skills

• Good understanding on other related LOBs

Academic Qualification

• Associate or bachelor's degree preferred

Mandatory Requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Preferred Requirements:

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.



Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.