Supervisor, Claim Adjudication Operations

About the Role

As a key member of the claim adjudication team, the Supervisor will work closely with their team to identify, recommend, develop, implement, support, and improve customer-focused solutions. This will involve collaborating with internal stakeholders, including customer service representatives, pharmacists, and other operations teams, to ensure seamless delivery of services. The Supervisor will also be responsible for planning, designing, coordinating, and aligning resources to support the daily activities of the team.

The claim adjudication team is a dynamic and fast-paced environment, requiring strong leadership and organizational skills to ensure that goals are met and customer expectations are exceeded. The Supervisor will be responsible for overseeing the work of their team, providing guidance and support as needed, and fostering a culture of continuous improvement and learning.

What You Will Do

• Oversee the day-to-day activities of the claim adjudication team, ensuring accurate and efficient administration of benefits
• Provide superior customer service, utilizing a high-touch, customer-centric approach focused on collaboration and communication
• Collaborate with internal stakeholders, including customer service representatives, pharmacists, and other operations teams, to ensure seamless delivery of services
• Plan, design, coordinate, and align resources to support the daily activities of the team
• Identify, recommend, develop, implement, support, and improve customer-focused solutions
• Run department Kanban boards and huddles, including sizing of work requests
• Perform 1:1s with team members to elicit feedback, provide mentorship, discuss career development, address performance, and provide workload and project guidance
• Perform workforce management duties, including overtime needs, time out of the office, and time tracking
• Adhere to department-level objectives, ensuring alignment with division and company strategic initiatives
• Participate in, adhere to, and support compliance and diversity, equity, and inclusion program objectives

What We Are Looking For

• Bachelor's degree or equivalent work experience
• At least 4 years of experience in operations management, preferably in the healthcare or pharmacy benefit management industry
• Strong knowledge of Excel and other Microsoft Office applications
• Excellent communication and interpersonal skills
• Ability to work in a fast-paced environment, prioritizing multiple tasks and meeting deadlines
• Strong leadership and organizational skills, with experience in supervising a team
• Knowledge of claim adjudication processes and procedures
• Experience with process improvement and quality assurance
• Strong analytical and problem-solving skills
• Ability to work collaboratively with internal stakeholders and external partners

Nice to Have

• Professional PBM industry work experience
• Knowledge of one or more responsibilities as defined above
• Experience with project management tools and software
• Certification in operations management or a related field

Benefits and Perks

• Competitive salary and benefits package
• Opportunity to work with a dynamic and growing company
• Collaborative and supportive work environment
• Professional development and growth opportunities
• Flexible work arrangements, including remote work options
• Access to cutting-edge technology and tools
• Comprehensive health insurance and wellness programs
• Generous paid time off and holiday schedule

• Tip: Highlight your experience with Excel and other Microsoft Office applications, as these are essential skills for this role.
• Tip: Showcase your ability to work in a fast-paced environment, prioritizing multiple tasks and meeting deadlines.
• Tip: Emphasize your strong leadership and organizational skills, including experience in supervising a team.
• Tip: Be prepared to discuss your experience with claim adjudication processes and procedures, as well as your knowledge of process improvement and quality assurance.
• Tip: Research the company culture and values, and be prepared to discuss how your skills and experience align with Navitus's mission and goals.
• Tip: Consider creating a portfolio or examples of your work, demonstrating your ability to analyze data, identify trends, and develop solutions.
• Tip: Be prepared to negotiate salary and benefits, and do not be afraid to ask questions about the company culture and expectations.