Supervisor, Claims Services

Location

Missouri

Posted

6 hours ago

Salary

$47.3K - $67.6K / year

Seniority

Senior

Professional Certificate5 yrs expEnglish

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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