Manager, Medical Claim Adjustments (Medicaid) (remote)

Job Description

About Conduent

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.

You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Job Description

Responsibility Statements

Oversees day-to-day operations (functions and activities) for the medical claim adjustments and corrections team, including people management and operational subjects.

Provides expertise and general claims support to teams in reviewing, researching, investigating, processing, and adjusting claims.

Assists in business unit performance driving SLAs and adherence to business unit metrics.

Drives innovation and efficiencies of business opportunities, applying processes improvements, and new systems.

Helps manage employee teams through coaching and development

Addresses people matters and identifies development opportunities.

Day-to-day operations client contact to resolve systems issues.

Provides feedback to clients on quality and workload issues.

Generates reports on performance measurement and KPIs to facilitate business decisions.

Lead project management and implementation activities

Performs other duties as assigned.

Complies with all policies, procedures, and standards.

Required Qualifications:

Bachelor’s Degree (or higher)

5+ years of supervisory/managerial experience in claims adjudication (medical claim processing, adjustments, and corrections) and/or Provider Dispute Resolution (PDR) process

2+ years of managing relationships with clients and/or vendors

Intermediate skills with Microsoft Word (create and edit documents and add visual aids), Microsoft Excel (create, edit, sort, filter, create pivot tables), and Microsoft PowerPoint (create and edit presentation)

Preferred Qualifications:

Understanding of claims processing systems

10+ years of healthcare claims leadership experience

Senior Level Supervisory/Managerial experience in medical claims

Job Track Description:

Requires broad technical expertise and industry knowledge.

Accountable for program management functions.

Assists others in achieving goals.

Manages performance appraisals and pay reviews.

Manages training for 3 or more employees.

Manages hiring and termination actions.

Requires broad technical expertise and company/industry knowledge.

Is accountable for program management functions.

General Profile

Accountable for team performance and results.

Manages professional employees and/or supervisors.

Adapts plans and priorities based on resource and operational challenges.

Acts based on policies, procedures.

Provides technical guidance to employees, colleagues, and customers.

Functional Knowledge

Understands and applies concepts in the field of expertise.

Has growing knowledge of other disciplines.

Business Expertise

Translates strategy and priorities into work product.

Impact

Positively impacts the level of service.

Impacts the team’s ability to meet quality, volume, and timeline targets.

Guides based on policies, resource requirements, budgets, and business plans.

Leadership

Builds team engagement to meet service and operational challenges.

Provides recommendations for OT, operational expenses, and rollup data.

Problem Solving

Resolves technical, operational, and organizational problems.

May take part in solving problems across a matrix.

Interpersonal Skills

Guides and influences internal and external customers, or agencies.