Senior Manager, Claims Quality Improvement

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

📋 Description

• Drive significant quality initiatives within a multifaceted claims operation.

• Provide guidance and direction for ongoing quality enhancement initiatives.

• Examine reports to uncover trends and opportunities, suggesting improvement initiatives.

• Identify risks and promote enhancements in claims quality, payment precision, audits, controls, and overall business outcomes.

• Spearhead extensive quality initiatives and operational excellence projects.

• Manage the NCQA accreditation process and ensure compliance with contractual obligations.

• Organize company-wide quality assessment and improvement efforts.

• Oversee annual file audits and various corporate and contractual quality initiatives.

• Implement tools, processes, reports, and audits to manage critical processes and program attributes.

• Suggest quality improvement opportunities and collaborate with management, the Quality Improvement Committee, and other committees to develop and apply solutions.

• Provide insights to correct errors and prevent recurring inconsistencies.

• Supervise monthly and quarterly reports and data to identify trends, improvement opportunities, and necessary interventions.

• Maintain policies and operational procedures, ensuring alignment of goals with both internal and external standards.

⛳️ Requirements

• Bachelor's degree in Business, Healthcare, or a related field.

• Master's degree is preferred.

• Over 5 years of experience in quality management or equivalent leadership roles.

• Previous experience as a lead in a specific functional area.

• Experience in managing cross-functional teams on large-scale projects or in a supervisory capacity.

• Supervisory experience that includes hiring, training, delegating tasks, and managing staff performance.

• Extensive knowledge of claims operations, payment accuracy, audit methodologies, quality management systems, regulatory requirements, and operational controls.

• Strong analytical and problem-solving abilities.

• Familiarity with data analysis, root cause analysis, statistical methods, and Lean/Six Sigma principles.

• Understanding of business systems, automation, reporting tools, and emerging AI capabilities.

• Knowledge of NCQA accreditation and contractual compliance requirements.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

• Flexible work options, including remote, hybrid, field, or office schedules.

• Additional incentive forms may be included in total compensation.

• Equal opportunity employer committed to diversity.