Claims QA Auditor – Lead
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Job Description
Claims Auditor Lead responsible for managing Quality Assurance Team and overseeing claims audits in a healthcare company. Engaging in mentorship and performance improvement initiatives.
Responsibilities:
- Oversight and management of the Claims Quality Assurance Team, including mentoring the team, implementing and coaching through performance improvement plans, and training auditors on job performance expectations.
- Reviewing 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.
- Managing the inventory of audits against standard service level agreements (SLA’s) and reporting requirements.
- Compiling 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 the 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.
Requirements:
- High School diploma or GED required, Associate or Bachelor’s degree preferred.
- Minimum of three (3) years of experience in a claim examiner or quality assurance role with a health care company, meeting production and quality goals/ standards.
- Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines.
- Proficient experience in MS Word, Excel, Outlook, and PowerPoint.
Benefits:
- Offers Equity
- Offers Bonus
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