Quality Claims Manager

Job Summary

Leading the Claims Quality team in a full-time remote capacity, the Quality Claims Manager will oversee quality assurance, manage audits, and drive continuous improvement across Medical, Dental, and Pharmacy Claims while ensuring operational effectiveness and compliance.

Key responsibilities

• Manage the day-to-day operations of the Claims Quality team, including performance monitoring and employee development
• Oversee quality audits and governance activities, ensuring consistent methodology and resolution of discrepancies
• Analyze audit findings and operational data to identify risks and improvement opportunities, implementing corrective actions as necessary

Required qualifications

• High School Diploma / GED or equivalent work experience
• 3+ years of healthcare claims experience involving Medical, Dental, or Pharmacy claims operations
• 2+ years of people-leadership experience with direct-report management responsibilities
• 2+ years of quality assurance or claims auditing experience
• Intermediate proficiency with Microsoft Excel and proficiency with Microsoft Word and PowerPoint