Description

The Claims Resolution and Reconciliation Supervisor oversees daily claims resolution operations, ensuring timely, accurate, and compliant processing of complex claims adjustments, provider disputes, appeals, and grievances. This role provides direct supervision to staff, supports operational performance, and ensures compliance with Department of Managed Health Care (DMHC) and Centers for Medicare & Medicaid Services (CMS) requirements, industry standards, and organizational standards.

Key Responsibilities

+ Supervise Claims Adjustment Specialists and Provider Dispute Resolution Analysts, including workload distribution, training, coaching, and performance management.
+ Oversee daily claims operations to ensure accurate and timely resolution of complex claims adjustments, disputes, and escalated issues.
+ Monitor productivity, quality, and inventory metrics to support operational goals and identify trends or areas for improvement.
+ Ensure...