Healthcare Claims Supervisor

Healthcare Claims Supervisor (Onsite)

Work Set-Up: Office-based (Onsite)

Location: Makati, Valero

Position Summary
The Claims Adjudication Supervisor is responsible for leading, developing, and managing the end-to-end medical claims adjudication function for US health plan operations. This role ensures high-quality claims processing, operational accuracy, adherence to KPIs and SLAs, and exceptional client communication.

The supervisor will be accountable for building and executing comprehensive training programs (curriculum, modules, assessments, certifications), overseeing quality assurance processes, driving team accountability through structured performance management, and providing timely, consistent business reporting to both internal leadership and external clients.

This is a highly visible, client-facing role requiring strong communication skills, deep knowledge of U.S. healthcare claims adjudication, and the ability to lead teams in a fast-paced environment.

Key Responsibilities

Operations & Team Leadership

Oversee daily medical claims adjudication operations to ensure accuracy, productivity, and SLA compliance.

Monitor KPIs, quality metrics, and team performance through dashboards, coaching, and regular performance reviews.

Lead escalations, workforce accountability, and continuous improvement initiatives to reduce errors and processing delays.

Training & Development

Own the end-to-end training program, including curriculum development, onboarding, uptraining, certifications, and refresher training.

Develop and maintain SOPs, training materials, assessments, and learning modules.

Track training effectiveness and provide regular progress reporting to leadership and clients.

Quality Assurance

Manage QA processes, audit programs, calibration sessions, and error trend analysis.

Ensure consistency in quality scoring, oversee rebuttal handling, and implement corrective action plans.

Provide QA insights, root-cause analysis, and performance recommendations.

Client Communication & Reporting

Serve as the primary operational contact for client communications and escalations.

Deliver timely business reviews and reports covering productivity, quality, SLA performance, and improvement initiatives.

Maintain consistent and professional communication with internal and external stakeholders.

Compliance & Cross-Functional Collaboration

Ensure compliance with operational standards, client requirements, and regulatory guidelines.

Partner with HR, QA, Training, Workforce Management, and Client Services teams to support operational goals and execution.

Qualifications

5+ years of experience in U.S. healthcare claims adjudication, with deep end-to-end process knowledge.

2–3 years of leadership experience managing claims adjudication teams (35-50 FTEs).

Strong understanding of medical terminology, coding (ICD, CPT, HCPCS), plan structures, and benefit rules.

Excellent verbal and written communication skills; highly responsive and professional with clients.

Demonstrated ability to create training programs, curriculum, modules, and certification paths.

Experience managing KPIs and SLAs in a BPO or healthcare operations environment.

Strong analytical and problem-solving abilities; comfortable with data-driven decision-making.

Ability to work in a fast-paced environment and manage multiple priorities.

Experience supporting U.S. health plans or TPAs.

Exposure to AI-assisted adjudication tools or digital transformation initiatives.

Background in quality assurance or instructional design.

Key Competencies

Operational Excellence – Drives KPIs, SLAs, quality, timelines.

Training & Development – Builds world-class training ecosystems.

Quality Management – Deep expertise in audits, trends, calibrations.

Client Communication – Clear, timely, professional, solutions-oriented.

Leadership – Coaches leaders and frontline staff; builds high-performing teams.

Accountability – Ensures consistent follow-through and ownership.

Strategic Thinking – Anticipates risks, proposes improvements, aligns stakeholders.

Additional Benefits:

HMO - Medical & Dental (coverage on Day 1 plus 1 dependent)

Transportation Allowance

Equipment will be provided

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and

satisfaction with plans’ members and providers. 

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.