- Directly supervise the Claims Quality Assurance Team, including mentoring the team, implementing and coaching through performance improvement plans, and training auditors on job performance expectations.
- Implement performance improvement plans and guide team members through corrective action as needed.
- Oversee audits of claims, ensuring processing accuracy by verifying all aspects of the audit have been handled correctly and according to both standard processes and the Client’s summary plan description.
- Monitor the inventory of audits against standard service level agreements (SLA’s) and reporting requirements.
- Compiling and distribute reporting of audits completed, with decision methodology for procedural and monetary errors which are used for quality reporting and trending analysis utilizing quality tools.
- Identifying trends based on quality reviews, identifies quality improvement opportunities and partners with training team to develop programs.
- Partnering with Claims Department Leadership and Training Lead on any problematic issues warranting immediate corrective action.
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