Medicaid Claims Supervisor

Conduent State Healthcare, LLC•Albuquerque, NM

2d•$51,205 - $66,500•Hybrid

About The Position

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.

Requirements

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.

Nice To Haves

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.

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.