Categories: Customer Support & Administration
Req ID: 2021-46528
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.
- 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.
- 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)
- 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.
- 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.
- Understands and applies concepts in the field of expertise.
- Has growing knowledge of other disciplines.
- Translates strategy and priorities into work product.
- 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.
- Builds team engagement to meet service and operational challenges.
- Provides recommendations for OT, operational expenses, and rollup data.
- Resolves technical, operational, and organizational problems.
- May take part in solving problems across a matrix.
- Guides and influences internal and external customers, or agencies.
Clipped from: https://jobs.conduent.com/job/13813067/manager-medical-claim-adjustments-medicaid-remote-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic