Supervisor, Claims Quality Auditor

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

📋 Description

• Supervision and administration of the Claims Quality Assurance Team, which includes mentoring team members, implementing and guiding performance improvement plans, and training auditors on expected job performance standards.

• Conducting reviews of claims audits to ensure processing accuracy by confirming that all aspects of the audit are addressed correctly and in alignment with both standard procedures and the Client’s summary plan description.

• Managing the audit inventory in accordance with established service level agreements (SLA’s) and reporting obligations.

• Compiling reports of completed audits, detailing decision-making methodologies for procedural and monetary errors utilized in quality reporting and trend analysis, leveraging quality tools.

• Recognizing trends from quality assessments, pinpointing opportunities for quality enhancements, and collaborating with the training team to create development programs.

• Collaborating with Claims Department Leadership and the Training Lead on any critical issues that require immediate corrective measures.

⛳️ Requirements

• High School diploma or GED is mandatory, with an Associate or Bachelor’s degree preferred.

• At least three (3) years of experience in a claims examiner or quality assurance capacity within a healthcare organization, achieving production and quality objectives/standards.

• Comprehensive understanding of relevant systems and a proven grasp of processing principles, techniques, and guidelines.

• Capability to acquire and execute increasingly complex skills and tasks in a production setting.

• Proficient in MS Word, Excel, Outlook, and PowerPoint.

• Experience with a highly automated and integrated claims adjudication system.

🏝️ Benefits

• Provides Equity

• Provides Bonus