Claims Quality Assurance Supervisor

This is a fully remote position, open to applicants in California.

📋 Description

• Lead and manage a team of para-professional staff members.

• Strategize and execute the claims quality assurance process.

• Ensure claims payments are accurate and timely while adhering to Medicare, Medicaid, contractual, and regulatory guidelines.

• Foster continuous improvement through data-driven audits, trend analysis, and collaboration across functions.

• Enhance team development and optimize workflows.

• Establish quality standards that support operational excellence and precise claims processing.

• Supervise auditing operations to guarantee accurate and timely claims payments.

• Identify operational challenges and gaps, devise solutions, and propose enhancements to processing and training.

• Monitor progress and regularly communicate audit findings and status to relevant stakeholders.

• Suggest improvements based on identified trends and collaborate with management and other departments to implement changes.

• Create and revise team procedures, workflows, and resource documentation.

• Observe daily activities of team members and report any critical issues or concerns to management.

• Act as the primary resource and escalation point for quality assurance concerns.

• Provide direct supervision, support, and guidance to team members.

• Assess performance and deliver feedback, coaching, and counseling.

• Identify training needs and opportunities for enhancing performance.

⛳️ Requirements

• An associate degree is preferred, or relevant professional experience in a health plan environment focusing on billing, claims payment, coding, or similar functions may be accepted.

• A minimum of five (5) years of experience in health plans, such as managed care or PACE, is strongly preferred.

• Experience in a claims processing environment, particularly in claims auditing.

• Demonstrated progressively responsible experience with the ability to mentor team members is required.

• Familiarity with Medicare and/or Medicaid billing and guidelines.

• Capability to understand and analyze contractual and regulatory requirements and their impact on claims payments and resolutions.

• Ability to accurately process information promptly.

• Strong leadership, organizational, and communication skills.

• Experience in a data-driven organization, utilizing reports and data to prioritize and manage personnel and projects.

• Comprehensive understanding of claims processing and regulations.

• Excellent problem-solving skills and the ability to analyze issues and develop solutions.

• Proof of COVID-19 vaccination or a declination form is required before employment.

🏝️ Benefits

• Medical insurance coverage (Medical, Dental, Vision).

• 17 days of personal time off (PTO).

• 12 holidays observed annually.

• 6 sick days.

• 401K savings plan with matching contributions.

• Comprehensive compensation package, including base salary and bonuses.

• Additional benefits available.

• Adherence to COVID-19 vaccination policy and infection control/PPE standards.