Claims Quality Assurance Supervisor

📋 Description

• Oversee auditing activities to ensure claims are paid accurately and timely per regulations
• Identify issues and operational gaps, develop solutions, and recommend improvements
• Track progress and communicate audit results/status to stakeholders
• Recommend improvements based on trends and collaborate with other departments
• Create and update team procedures, workflows, and resource materials
• Monitor daily team activities and report critical issues

🎯 Requirements

• Associates degree preferred or relevant professional experience in health plan environment
• Minimum 5 years' experience in health plans (managed care or PACE strongly preferred)
• Experience in claims processing with emphasis on claims auditing
• Progressively responsible experience mentoring team members
• Working knowledge of Medicare/Medicaid billing and guidelines
• Ability to analyze contractual and regulatory requirements

🎁 Benefits

• Medical, Dental, Vision insurance
• 17 days PTO, 12 holidays, 6 sick days
• 401K savings + match
• Base pay and bonus
• Additional benefits