Supervisor, Claim Adjudication Operations

Role Overview

• Oversee roles within the Claim Adjudication Operations department to support accurate and timely configuration and data transfers of client hierarchy, benefits, and networks.
• Provide superior customer service utilizing a high-touch, customer centric approach focused on collaboration and communication.
• Outreach and collaborate with CAO customers/partners for day-to-day work and contribute to action plan creation.
• Oversight of work on Kanban boards, meeting turnaround times and performance guarantees.
• Run department Kanban board(s) and huddles, including sizing of work requests.
• Resource assignment of day-to-day work, audits, and root cause analysis/CAP.
• Perform 1:1s to elicit feedback from department associates, provide mentorship, discuss career development, address performance, and provide workload and project guidance.
• Perform workforce management duties for direct reports, including, but not limited to, overtime needs, time out of the office and time tracking.
• Apply soft skills toward team members and external stakeholders alike in understanding every point of view and coming to the table with good negotiation skills.
• Must have the ability to work with different personalities across all departments and understand their point of view to communicate accordingly.
• Adhere to department level objectives to ensure alignment with division and company strategic initiatives.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned.

Requirements

• Bachelor’s degree or equivalent work experience is required.
• 4 years of experience required.
• Knowledge of one or more responsibilities as defined above is strongly preferred.
• Professional PBM industry work experience is preferred.
• Knowledge of applicable data privacy practices and laws is preferred.
• Healthcare industry practices and HIPAA knowledge would be a plus.
• Experience as a member of a multi-disciplinary team is a plus.
• Understanding of human resource management principles, practices, and procedures would be a plus.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5%
• No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!