Claims Quality Audit Supervisor supervises and coordinates daily activities of claims quality auditors. Provides assistance in developing claims audit policies and procedures. Being a Claims Quality Audit Supervisor solves day-to-day problems and monitors the results of daily staff activities, reports critical issues and problems to the management. Typically requires a bachelor's degree. Additionally, Claims Quality Audit Supervisor typically reports to a manager. The Claims Quality Audit Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. Thorough knowledge of department processes. To be a Claims Quality Audit Supervisor typically requires 3-5 years experience in the related area as an individual contributor. (Copyright 2024 Salary.com)
The main function is to audit delegated and non-delegated professional, and facility claims for accurate processing per contract, health plan guidelines, State and Federal regulations within payment compliance time limits. This position will also be responsible for analyzing data, presenting data, and processing claims, if applicable.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)