Supervisor, Claims Services
Location
Missouri
Posted
6 hours ago
Salary
$47.3K - $67.6K / year
Seniority
Senior
Job Description
Supervisor, Claims Services
Gainwell Technologies
• Supervises claims audit operations within Pharmacy Benefit Management (PBM) services • Ensures accurate adjudication of pharmacy claims while maintaining compliance with Medicaid requirements and operational performance standards • Oversee claim audit workflows to ensure accuracy, timeliness, and compliance with PBM and Medicaid guidelines • Monitor performance metrics (productivity, quality, turnaround times) and implement process improvements to identify discrepancies • Manage escalations and resolve complex claims issues involving members, providers, and pharmacies • Partner with internal teams to support system updates, audits, and ongoing claims operations • Work with state to present audit findings, develop new capabilities and manage appeal processes
Job Requirements
- 5+ years of experience in pharmacy operations, drug claims processing, audit, or related healthcare environments
- 2+ years of leadership experience managing teams and driving performance
- Strong expertise in pharmacy claims adjudication, Medicaid programs, audit processes, and identifying claims anomalies
- Nationally Certified Pharmacy Technician (CPhT) required; CFE or AHFI certification preferred
- Experience with client communications, reporting (KPIs), and driving operational improvements
Benefits
- generous, flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- variety of leadership and technical development academies
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