Guides the development and activities of an organized team. Serves as the team's primary contact and assumes management responsibility for the team(s). Interfaces directly with internal or external customers as well as trains new employees and resolves customer concerns within a team to meet or exceed customer requirements. Responsible for maintaining a supportive work environment. Must conduct activities within guidelines set forth by individual state or federal regulations.
•Identifies, designs, develops, coordinates and performs audits of claims payments across all claims platforms.
•Authors corrective action plans in coordination with internal and or external partners.
•Develops audit reports requests.
•Reports financial and statistical results on a monthly basis.
•Identifies and develops operational and tactical business initiatives for the purpose of achieving desired financial goals related to the accomplishment of corporate, departmental and PIP targets as defined.
•Builds and maintains collaborative relationships with both internal and external customers / partners (including claims, compliance legal, configuration, networks, ASD, IT, care management, underwriting and accounting management) to achieve desired financial goals in relations to PIP targets.
•Fosters trust and confidence through demonstration of knowledge, ability, cooperation and follow up.
•Project manages entire implementation of corrective action plans and develops tools to measure financial impact of changes implemented going forward.
•Ensures application and adhere to all facets of Federal, State, Provider and group mandates.
•Demonstrates the ability to develop cost benefit analysis, R.O.I. and C.A.P. on perspective projects.
•Prioritizes activities in relation to R.O.I.

Other Job Requirements

Responsibilities
2+ years of supervisory experience.
3+ years of claims/collections experience.
Bachelor's Degree plus above experience or equivalent combination of experience and education.

General Job Information

Title
Supervisor, Payment Integrity

Grade
23

Work Experience - Required
Claims, Collections, Supervisory

Work Experience - Preferred

Education - Required
A Combination of Education and Work Experience May Be Considered., Bachelor's

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:
$53,125
Salary Maximum:
$84,995

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.