Claims Quality Assurance Supervisor

The role

The Claims Quality Assurance Supervisor develops and oversees a group of para-professional team members. This role ensures accuracy, efficiency, and compliance of processed claims on a pre and post pay basis.

What you will do

• Oversee auditing activities to ensure claims are paid accurately and timely.
• Identify issues and operational gaps and develop solutions.
• Track progress and communicate audit results to impacted parties.
• Make recommendations related to identified trends or improvements.
• Create and update team procedures, workflows, and resource materials.
• Monitor daily team member activities and report critical issues to management.
• Serve as the primary point of escalation for quality assurance issues.
• Evaluate team member performance and provide feedback, coaching, and counseling.
• Identify training gaps and opportunities for improved performance.

Required qualifications

• Minimum of five (5) years of experience in health plans.
• Experience in a claims processing environment with an emphasis on claims auditing.
• Progressively responsible experience with demonstrated ability to mentor team members.
• Working knowledge in Medicare and Medicaid billing and guidelines.
• Ability to understand and analyze contractual and regulatory requirements.
• Experience leading in a data-driven organization.
• Comprehensive knowledge of claims processing and regulations.
• Strong problem solving skills.

Nice to have

• Associate’s degree preferred.
• Managed care or PACE strongly preferred.

Benefits

• Medical insurance coverage (Medical, Dental, Vision)
• 17 days of personal time off (PTO)
• 12 holidays observed annually
• 6 sick days
• 401K savings + match
• Base pay and bonus

Before you apply

• Proof of vaccination, or a vaccine declination form will be required prior to employment.

About the company

WelbeHealth serves vulnerable seniors through shared intention, pioneering spirit, and the courage to love.