Claims Quality Audit Manager jobs in Florida

Imagenet, LLC is seeking an experienced Quality Manager, Claims Processing to join our team. In this role, you will be responsible for overseeing the performance and quality of our claims processing department.

Responsibilities:

Develop and implement quality assurance policies, procedures, and standards for claims processing

Monitor claims processing metrics such as productivity, accuracy, turnaround times, and customer satisfaction

Identify areas for improvement in claims processing and develop solutions

Conduct audits on a sample of processed claims to ensure adherence to regulations, guidelines, and quality standards

Analyze performance data, identify trends and root causes of defects, and suggest process improvements

Coach and mentor claims processing staff on performance, compliance, and career development

Create and manage quality assurance training programs for claims staff

Track quality standards and report on quality goals and progress to senior management

Requirements:

Previous claims processing quality management or related field preferred

5 years of experience in claims processing, including 3 years in a quality assurance role

Expert knowledge of claims processing procedures, quality standards, and regulatory requirements

Strong analytical and problem-solving skills

Ability to interpret data and generate detailed reports (daily/weekly/monthly) in graphs & presentations

Experience developing and conducting quality audits

Leadership skills with the ability to influence outcomes and drive change

Excellent communication and presentation abilities

This is an opportunity to oversee quality for a growing claims processing provider . If you have the required claims processing and quality assurance experience, please apply with your resume.

COMPANY OVERVIEW

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

Imagenet LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.