Medicaid Claims Supervisor

About the role

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. 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.

Benefits

• 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.