Supervisor, Claim Adjudication Operations
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Job Description
Supervisor managing Claim Adjudication Operations for Navitus, focusing on improving business processes and customer service. Collaborating with teams to ensure accurate benefits administration in a remote setup.
Responsibilities:
- 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!
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