Lead Claims Processor

Maryland Heights MO 63043 St Louis 1 14100 Magellan Plaza

Job Description

Work with management in the design, implementation and maintenance of claims processing programs and procedures. Verify that claims are being adjudicated according to Magellan contracts in a consistent and accurate manner. Manage projects and administrative duties as required by business need. Lead and implement positive changes with a high level of quality and professionalism. Be able to work independently, and act as a resource in Managers/Supervisors absence.

Essential Functions

- Assist and support Unit Supervisor
- Assist in providing daily leadership for associates to obtain optimal results
- Assist in managing daily inventory and workflows
- Interact and respond to the CMC/SBU
- Track and trend performance of root cause analysis and provide additional training as needed
- Prepare feedback and review to Supervisors and Managers
- Adjudicate claims and adjustments as needed
- Identify system/benefit errors; develop protocols and workflows to prevent future errors
- Handle all types of requests, inquiries and complaints accurately and timely, to include written correspondence and phone inquiries from internal customers.


Essential Functions

br>Assist with the maintenance and updating of the unit’s reference materials, Provide backup support to other team members in the performance of job duties as assigned, Complete various tasks as assigned by the Supervisor or Manager, Mentor team members, Continuously identify process improvements that impact quality and service results, Complete special projects as assigned by the Supervisor or Manager, Provide re-enforcement training for new associates as required, Other duties as assigned.

Minimum Requirements
- 3-5 Years Experience; 2 years Magellan claims adjudication
- Excellent decision-making, analytical, organizational, presentation, communication, coaching, and leadership skills; excellent command of ICD-9 and CPT coding.

General Job Information


Lead Claims Processor



Job Family

Operations Group


United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date


Date Requisition Created


Minimum Qualifications



License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


  • Ability to quickly use a 10-key machine
  • Excellent command of ICD-9 codes and Current Procedural Terminology (CPT)
  • Excellent decision making, analytical, organizational, presentation, communication (verbal and written), coaching and leadership skills.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled