Claims Quality Assurance Supervisor

Job Summary

Leading a team of para-professional members, the full-time remote Claims Quality Assurance Supervisor will develop and oversee quality assurance strategies to ensure accurate claims processing and compliance with regulatory requirements while fostering collaborative relationships across the organization.

Key responsibilities

• Oversee auditing activities to ensure timely and accurate claims payments in compliance with regulations
• Identify operational gaps and recommend improvements for processing and training
• Provide direct supervision and mentorship to team members, evaluating performance and addressing training needs

Required qualifications

• Associates degree preferred or relevant professional experience in a health plan environment
• Minimum of five years' experience in health plans, particularly in managed care or PACE
• Experience in a claims processing environment with a focus on claims auditing
• Demonstrated ability to mentor team members and lead in a data-driven organization
• Working knowledge of Medicare and Medicaid billing guidelines and their impact on claims processing