City and County of San Francisco

Medical Claims Supervisor (#8170)

$46.40-$56.43 Hourly / $8,043.00-$9,780.00 Monthly / $96,512.00-$117,364.00 Yearly


Definition

Under general direction, supervises and is responsible for the claims section of the health service system; plans, assigns and supervises the activities of subordinate employees engaged in processing medical claims records; and performs related duties as required. Requires responsibility for: explaining, interpreting arid enforcing policies, methods and procedures related to the audit and review of' all medical claims of members of the health service system; developing and installing new procedures in connection therewith; making regular contact with professional persons, hospitals, outside agencies and groups, arid members of the health service system to exchange information and to explain and interpret services and regulations related to payment of medical claims; preparing, checking and reviewing important detailed and complex medical claims and related statistical records arid reports.

Examples of Important and Essential Duties

1. Assigns, supervises arid reviews the work of employees of the claims section of the health service system: interprets departmental rules, regulations and policies to employees; screens and processes medical claims and audits claims processed by subordinates.

2. Answers inquiries from health service members regarding their claims on major medical coverage or on other disputed claim matters or benefits; assists members in preparing major medical claims forms by advising them of the type of evidence required to submit claims.

3. Prepares correspondence relative to benefits, liability arid claims insurance subrogations.

4. Reviews medical claims processing methods and procedures and institutes and recommends changes to improve efficiency of operation.

5. Discusses medical claims or medical services with doctors, hospitals, laboratories arid others.

6. Prepares information releases regarding the health service system.

7. Appears before groups to explain various benefits and answer questions concerning medical claims activities and services.

Knowledge, Skills and Abilities

Knowledge, Abilities and Skills: Requires considerable knowledge of: life, group, accident and health insurance; health, accident claims, compensation and disability evaluation; medical terminology.

Requires ability tot prepare clear, concise arid accurate reports; direct the work of others; deal courteously, effectively and tactfully with a variety of outside interests and groups.

Experience and Training

: Requires completion of high school, supplemented by at least six years of progressively responsible clerical experience involving health, accident, medical or similar insurance claims work, including two years of supervisory experience; or an equivalent combination of training and experience.

Disaster Service Workers

All City and County of San Francisco employees are designated Disaster Service Workers through state and local law (California Government Code Section 3100-3109). Employment with the City requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

CLASS: 8170; EST: 1/1/1900; REV: 1/1/1900;