Supervisor, Claims Provider Network Operations (PNM)

Role Overview: The Provider Network Operations Supervisor supports the daily operations of the Provider Network Operations team by overseeing staff performance, ensuring operational efficiency, and maintaining compliance with internal policies and contractual requirements.


Work Arrangement:


+ Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI.

+ Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)

+ Internet reimbursement may be available where required by law or contract


Responsibilities:


+ Supervise, coach, and monitor staff performance to ensure quality and timely completion of work

+ Support the Manager in implementing departmental initiatives and process improvements

+ Ensure operational processes align with internal policies, contractual obligations, and service level agreements (SLAs)

+ Oversee and support the resolution of provider inquiries and complaints, ensuring timely and effective outcomes

+ Monitor provider data maintenance and/or claims-related activities, providing feedback and recommendations for improvement

+ Research and resolve complex claims issues and operational discrepancies

+ Identify operational challenges and recommend solutions to improve performance and compliance

+ Participate in special projects and perform additional duties as assigned


Education & Experience:


+ Associate degree required or equivalent combination of education and relevant work experience

+ 1 to 3 years of supervisory or leadership experience preferred

+ Experience in managed care or a healthcare environment preferred

+ Knowledge of claims processing, coding, payment, and/or provider data operations strongly preferred

+ Familiarity with Medicaid reimbursement methodologies preferred


Skills & Abilities:


+ Strong leadership and team development capabilities

+ Knowledge of healthcare operations, particularly claims and provider data

+ Analytical and problem-solving skills with attention to detail

+ Ability to manage multiple priorities in a fast-paced environment

+ Strong communication and interpersonal skills

+ Ability to identify process improvement opportunities and drive change
As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.