Healthcare Claims Supervisor

Position: Healthcare Claims Supervisor
Location: Remote, Eastern Standard Time (EST) based in the Continental United States.
Reports To: Program Director

Overview:
J29 is an employee centered health and human service management consulting company that specializes in processing, reviewing, and analyzing claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes employee experience. Our team brings corporate performance where we provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs.

J29 is seeking an experienced Healthcare Claims Supervisor to support the World Trade Center Health Program Third-Party Administrator contract. Reporting to the Program Director, this position will provide daily supervisory oversight and technical leadership for a growing healthcare claims processing team. The team is expected to begin with at least two direct reports and expand as program operations grow.

The Healthcare Claims Supervisor will be responsible for staff direction, claims quality, productivity, operational readiness, and consistent application of program requirements. The role requires strong knowledge of healthcare claims adjudication, coordination of benefits (COB), claims system workflows, and new program implementation. Experience using the PLEXIS claims system is strongly preferred.

Duties:
Team Supervision and Daily Operations
- Supervise a growing team of healthcare claims staff, with responsibility expected to expand as claim volumes increase.

- Provide daily work direction, assign priorities, balance workloads, monitor queues, and ensure timely completion of claims processing activities.

- Conduct regular individual and team check-ins, provide coaching, communicate expectations, and address operational barriers.

- Monitor attendance, productivity, quality, accuracy, and adherence to established procedures and performance expectations.

- Escalate staffing, performance, system, policy, or operational risks to the Program Director with recommended corrective actions.

- Support employee onboarding, cross-training, knowledge development, and succession planning as the team expands.

Claims Processing and Technical Oversight
- Provide supervisory and technical oversight for end-to-end healthcare claims intake, review, adjudication, payment, denial or rejection, adjustment, and escalation processes.

- Serve as an operational subject matter expert for complex claims, claim edits, exceptions, reimbursement questions, and processing issues.

- Ensure consistent interpretation and application of program requirements, benefit rules, covered conditions, reimbursement guidance, and claims processing procedures.

- Review and help resolve complex or escalated claims issues using applicable policies, procedures, system information, and supporting documentation.

- Partner with program leadership and cross-functional stakeholders to address recurring claim issues and improve processing consistency.

Coordination of Benefits
- Oversee coordination of benefits processing, including primary and secondary payer determination, Medicare coordination, Other Health Insurance (OHI), workers compensation coordination, and related recovery activities.

- Ensure COB claims are processed in accordance with program rules, payer order requirements, available remittance information, and established procedures.

- Provide guidance on complex COB scenarios, payment calculations, duplicate coverage, liability considerations, and claims requiring additional information.

- Identify COB-related trends, errors, and training needs, and recommend procedural or system improvements.

New Program Implementation and Operational Readiness
- Support the design, implementation, and startup of new healthcare claims ope