Claims Quality Assurance Supervisor
Core
Lead a team of para-professionals to ensure accuracy, efficiency, and compliance of processed claims on a pre and post pay basis for vulnerable seniors.
Role type
Senior management supervisor (claims quality assurance)
Builds
Accurate, compliant claims payments and improved operational workflows
Domain
Healthcare / Managed Care / PACE
Required skills
Claims auditing, Medicare/Medicaid billing guidelines, regulatory compliance analysis, team supervision, performance evaluation, workflow optimization, data-driven trend analysis, problem solving
Preferred skills
Associate degree, 5+ years in health plans (managed care/PACE), claims processing environment experience, mentoring experience
Technologies
None stated
Responsibilities
Oversee auditing activities for accurate and timely claims payments; Identify operational gaps and develop solutions; Track and communicate audit results; Create and update team procedures and workflows; Monitor team member activities and report critical issues; Provide direct supervision, coaching, and performance evaluations
Seniority
Senior, management team member