The Medicaid Expansion supervisor provides consulting utilizing knowledge and expertise on insurance and healthcare.
Develops and implements general insurance and health policies in accordance with state and federal laws. Provides
expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider
appeals and meets with providers to resolve problems/issues. Provides directions for utilization review. Approves any
remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and
works with organized healthcare groups and associations on various medical issues related to insurance and healthcare
- Supervise a team primarily comprised of non-exempt employees or contingent workforce with well-defined, limited scope,
including directing daily work activities/priorities, time tracking, people recruitment and development, cost management
and workforce planning. Provides general supervision and guidance within one functional area.
- Act as a resource to staff related to benefit and salary administration. Assists with hiring tasks. Manage FPR process for
employees. Manage team and individual performance. Monitors team members’ progress on goals.
- Ensure services are provided on standard, specialized or complex systems. Ensure processes and procedures, are
documented and reviewed/updated on a regular basis.
- Resolve-monitor routine customer escalations as appropriate. Solves routine issues within established guidelines.
Escalates issues for which there is not a document procedure or precedent set.
- Reviews production reporting as required to support processes. Lead team toward operational excellence by monitoring
key metrics, ensuring team goals and contractual commitments are met. Monitors Service Level Agreements. Produce
goals to include process improvements.
- Provides production data to upper management as appropriate. Good people management ability and handles all
people care related activities. Creates a working environment that is conducive to individual growth, high performance, is
challenging and rewarding