Medicaid Claims Supervisor

Medicaid Claims Supervisor

The Medicaid Claims Supervisor is responsible for leading the day-to-day operations of a Medicaid claims processing team, ensuring the accurate, timely, and compliant adjudication of claims in support of state Medicaid program objectives.

This role combines operational leadership, staff development, quality oversight, and stakeholder collaboration to drive performance, resolve complex claims issues, and maintain compliance with CMS regulations, state requirements, and contractual service standards.

The ideal candidate brings strong Medicaid claims expertise, leadership experience, and a commitment to continuous improvement in a fast-paced healthcare operations environment.

Responsibilities

• Supervise, coach, and develop a team of Medicaid claims processors, analysts, and support staff.
• Monitor daily claims processing activities to ensure timely, accurate, and compliant adjudication of Medicaid claims.
• Manage escalated claims issues, Tier 3 claims escalations, payment discrepancies, provider concerns, and operational exceptions through effective resolution strategies and cross-functional collaboration.
• Ensure achievement of service level agreements (SLAs), key performance indicators (KPIs), quality standards, and contractual requirements.
• Review operational reports and performance metrics to identify trends, risks, and opportunities for improvement.
• Investigate and resolve escalated claims issues, payment discrepancies, and provider inquiries.
• Support quality assurance activities, audits, corrective action plans, and process improvement initiatives.
• Ensure compliance with CMS regulations, state Medicaid policies, HIPAA requirements, and established operating procedures.
• Coordinate with internal departments, state agencies, providers, and client stakeholders to resolve operational issues.
• Support workforce planning, scheduling, training, and employee development activities.
• Maintain documentation, operational procedures, and workflow standards.
• Participate in system enhancements, testing activities, and special projects as assigned.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field; or equivalent combination of education and experience.
• Minimum of three (3) years of Medicaid claims processing experience.
• Minimum of two (2) years of supervisory, team lead, or leadership experience.
• Knowledge of claims adjudication, provider reimbursement methodologies, and healthcare operations.
• Experience monitoring performance metrics, productivity standards, quality measures, and service levels.
• Strong analytical, problem-solving, and decision-making skills.
• Excellent written, verbal, and interpersonal communication skills.
• Proficiency with Microsoft 365 applications, including Outlook, Excel, Word, PowerPoint, and Teams.

Preferred Qualifications

• Experience supporting a Medicaid Management Information System (MMIS) environment.
• Knowledge of CMS regulations, Medicaid State Plan requirements, and healthcare industry standards.
• Experience managing claims resolution, provider communications, appeals, adjustments, or reimbursement activities.
• Prior experience supporting government healthcare programs or public sector contracts.
• Experience leading process improvement, workflow optimization, and operational transformation initiatives.
• Lean, Six Sigma, or quality management experience.
• Knowledge of healthcare billing, coding, and reimbursement methodologies.

Flexible Working

At Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone too.

In this role, you can expect the following working conditions:

Hybrid work: Work in a way that allows you to work from home and have time onsite when needed to connect with other team members and business leaders.

Working For You

Perks and rewards designed for you:

Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment

Retirement Savings: We will support you as you save for your future.

Employee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.

Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.

Paid Training: Earn while you learn and continue to grow with access to award-winning learning platforms throughout your Conduent career.

Paid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work.

Great Work Environment: We are proud of our award-winning culture and the recognition we've received for our diversity efforts.

Join Us

At Conduent, we are one team, one mission. We understand that our success is directly related to the success of our associates.

We strive to create a culture where you can:

• Bring your authentic self to work.
• Grow and thrive, both personally and professionally.
• Make a difference with our clients, in our communities, and with the millions of people we support.

When you join Conduent, you are engaged in creating the future - both our company's and your own. With more than 60,000 associates across 24 countries, we will provide you the opportunity to grow with a team of people who will challenge and inspire you to be the best!

Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $51,205-$66,500.

About the Team

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

Job Info

• Job Identification 25299
• Job Category Delivery Management
• Locations 1720 Randolph Rd SE Suite 100, Albuquerque, NM, 87106, US (Hybrid)