Supervisor Claims QA
New
C
CentivoHealth Insurance
All other applicants will be considered for remote positions.Full-TimeManager
Salary70,000 - 78,000 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of five (5) years of experience in a claim processor or quality assurance role
- Required Skills
- LeadershipMS OfficeReportingQuality Assurance
Requirements
- Minimum of five (5) years of experience in a claim processor or quality assurance role with a health care company.
- Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines.
- Strong knowledge of benefit plans, policies, and procedures, with an understanding of medical terminology.
- Proficiency in MS Office applications.
- High School diploma or GED required, associate or bachelor’s degree preferred.
- Experience leading and delegating tasks to multiple direct reports.
- Prior supervisory or lead experience with direct reports preferred.
- Experience with a highly automated and integrated claim adjudication system; El Dorado-Javelina and/or Health Rules Payer experience preferred.
Responsibilities
- 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.
View Full Description & ApplyYou'll be redirected to the employer's site
