Supervisor, Insurance Analyst

Role Summary

The Supervisor, Insurance Analyst provides leadership, support, and supervision for the Insurance Analyst team. This individual is a subject matter expert on commercial pharmacy, major medical, and government insurance plans, prior authorizations, appeals, and alternate coverage referrals. The supervisor ensures that day-to-day activities operate smoothly to provide the best customer experience for physician offices and patients, and is responsible for meeting performance metrics and workload deliverables within a high-touch model.

Responsibilities

• Supervise and oversee insurance analysts responsible for verifying new patient insurance benefits and handling claim rejections. Work proactively with staff and cross-functional groups to develop solutions to patient access issues regarding prior authorization and denied coverage requests to ensure patient care.
• Partner with leads to monitor workflow and adjust workload and staffing to ensure timely and efficient completion of activities.
• Monitor calls and perform case reviews to ensure accuracy, policy adherence, and excellent customer service. Provide coaching and training as needed; conduct regular performance conversations and write/communicate performance reviews.
• Perform administrative tasks such as scheduling, attendance monitoring and counseling, vacation requests, and overtime; participate in hiring and handle employee issues for direct reports.
• Use effective coaching to maintain a motivated, interactive staff.
• Meet or exceed department standards for performance metrics; provide periodic progress reports, activity metrics, status updates, and local payor intelligence. Elevate issues as appropriate.
• Build and maintain cross-functional relationships to ensure seamless patient and physician experiences.
• Identify process improvements to increase operational efficiencies and develop action plans; assist with implementing new projects and products within the Pharmacy.
• Understand and comply with training, including federal/state/local laws, HIPAA/privacy policies, and business procedures.
• Perform additional tasks and projects as deemed necessary by management.

Qualifications

• Required: 3–5 years of experience in the healthcare industry with knowledge in reimbursement, billing, prior authorization, appeals, and specialty pharmacy operations.
• Required: 1–2 years supervisory experience in a call center, large physician, managed care, or healthcare insurance setting.
• Required: Demonstrated strong, accurate technical skills; detail-oriented; thorough understanding of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations.
• Required: Proven leadership and coaching skills with ability to lead and participate in a team, manage multiple priorities, and meet timelines while maintaining accuracy.
• Required: Professional written and verbal communication skills to interact with all levels of the organization; maintain a positive service image under challenging circumstances.
• Required: Strong organizational, time management, and problem-solving skills; ability to elevate to management when appropriate.
• Required: Proficiency with Microsoft Office; ability to learn and navigate other computer systems.
• Preferred: Bachelor’s degree or Associate Degree in health sciences or business; comparable or relevant experience considered.
• Preferred: Additional leadership and coaching experience.

Education

• Bachelor’s degree or Associate Degree in health sciences or business preferred; comparable or relevant experience will be considered.

Skills

• Microsoft Office proficiency; ability to learn and navigate additional computer systems
• Strong written and verbal communication
• Excellent organizational and problem-solving abilities
• Customer-focused with ability to build cross-functional relationships