Role Overview: The Provider Network Operations Supervisor supports the daily operations of the Provider Network Operations team by overseeing staff performance, ensuring operational efficiency, and maintaining compliance with internal policies and contractual requirements.
Work Arrangement:
Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI.
Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)
Internet reimbursement may be available where required by law or contract
Responsibilities:
Supervise, coach, and monitor staff performance to ensure quality and timely completion of work
Support the Manager in implementing departmental initiatives and process improvements
Ensure operational processes align with internal policies, contractual obligations, and service level agreements (SLAs)
Oversee and support the resolution of provider inquiries and complaints, ensuring timely and effective outcomes
Monitor provider data maintenance and/or claims-related activities, providing feedback and recommendations for improvement
Research and resolve complex claims issues and operational discrepancies
Identify operational challenges and recommend solutions to improve performance and compliance
Participate in special projects and perform additional duties as assigned
Education & Experience:
Associate degree required or equivalent combination of education and relevant work experience
1 to 3 years of supervisory or leadership experience preferred
Experience in managed care or a healthcare environment preferred
Knowledge of claims processing, coding, payment, and/or provider data operations strongly preferred
Familiarity with Medicaid reimbursement methodologies preferred
Skills & Abilities:
Strong leadership and team development capabilities
Knowledge of healthcare operations, particularly claims and provider data
Analytical and problem-solving skills with attention to detail
Ability to manage multiple priorities in a fast-paced environment
Strong communication and interpersonal skills
Ability to identify process improvement opportunities and drive change
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
