Medicare Supervisor Claims Reviewer

Overview

Employer Industry: Healthcare Services

Why consider this job opportunity:

• Salary up to $ annually
• Comprehensive benefits package and bonuses based on performance
• Opportunity for career advancement and professional growth within the organization
• Flexible remote work option available from most U.S. states
• Supportive and collaborative work environment focused on continuous learning
• Chance to make a significant impact on healthcare claims processing

• Supervise and manage a team of claims reviewers to ensure accurate and timely healthcare claims processing
• Oversee claims review and analysis for compliance with healthcare regulations and payer requirements
• Resolve escalated or complex claims issues, ensuring appropriate adjudication and dispute resolution
• Monitor team performance, provide feedback, and conduct regular evaluations to support professional growth
• Collaborate with billing, coding, and compliance teams to ensure adherence to regulatory and payer standards

• Bachelor's Degree required (experience can be substituted in lieu of degree)
• At least 3‑5 years of experience in healthcare claims review or processing
• Minimum of 1‑2 years of experience in a senior or leadership role
• Strong knowledge of healthcare claims processes, coding (CPT, ICD‑10), and payer regulations
• Proficiency in claims processing software and healthcare management systems

• Medicare Advantage claims experience is highly preferred
• Experience with QNXT is highly preferred
• Excellent leadership, communication, and problem‑solving skills
• Strong attention to detail with the ability to manage multiple tasks and priorities