Claims Quality Audit Supervisor jobs in Oregon

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)

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Quality Audit Specialist I
  • Moda Health
  • Milwaukie, OR FULL_TIME
  • Let’s do great things, together

    Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

    Provider accurate and quality audits through all Customer Service channels (online chat, Inbound/Outbound phone calls, internal/external emails and post contact surveys) for all lines of business within Moda Customer Service: Medical, Dental, Pharmacy, Benefit Help Solutions and Technical Support (specialty areas: EOCCO/OHP, Individual Membership OR/WA/AK, NCQA, Performance Guarantee Groups, Specialized, Medical Intake, Technical Support, COBRA, FSA and PERS). Monitor customer contacts by selecting call recordings, voicemails, and emails, online chat transcriptions for services provided by Customer Service Agents, Technical Support Specialists, 3rd Party Vendors, Department Leads and trainees.  Ensure compliance with State (EOCCO/OHP), Federal (CMS) and internal policies are met. Provide objective feedback to maintain quality assurance on all methods of contact for all lines of business and to provide ongoing training.
     

    ​​​​This is a Remote PST position. We are only offering this position to candidates living in or willing to relocate to AK, AZ, ID, OR, TX, or WA. 

    Please follow the link below to apply to this position:

    • https://j.brt.mv/ATS/jb.do?reqGK=27688241
    ​​​​​​Benefits:
    • Medical, Dental, Vision, Pharmacy, Life, & Disability
    • 401K- Matching
    • FSA
    • Employee Assistant Program
    • PTO and Company Paid Holidays

    Schedule:

    • PST
    Requirements:
    1. High School Diploma or equivalent.
    2. 6 months – 2 years health insurance claims processing or customer service dealing with all types of plans/claims consistently exceeding performance levels.
    3. Strong reading, writing and verbal communication skills.
    4. Good analytical, problem solving, decision making and detail oriented skills with ability to shift priorities.
    5. 10 key proficiency of 105 spm on a computer numeric keypad.
    6. Type a minimum of 25 wpm on keyboard.
    7. Good organizational ability that allows working under pressure, handling a variety of functions and timelines while remaining up to date on changing and new information.
    8. Ability to work well under pressure in a complex and rapidly changing environment.
    9. Ability to track and coordinate multiple projects and meet timelines.
    10. Knowledge and understanding of Moda Health administrative policies and procedures affecting claims and customer service.
    11. Understand large group and individual healthcare insurance dynamics and provisions, including funding types, benefit designs, as well as Moda Health/Delta Dental benefit administration policies.
    12. Ability to communicate positively, patiently and courteously.
    13. Proficient in Microsoft Excel, Word and Moda operating.
    14. Ability to maintain confidentiality and project a professional business image.
    15. Ability to come into work on time and on a daily basis.
    16. Ability to adhere to Moda attendance and flex time policy.
    17. Knowledge of 1 or more customer Service related departments, including Medical, Medical Intake, Pharmacy, Dental, Tech Support, BHS, Government Programs, NCQA, PG, OHP and EOCCO with ability to be cross trained on multiple lines.
    18. Communicate open and effectively with the support leadership team.
    19. Ability to learn how to multitask between chat, email and phone Customer Service etiquette and differences with attention and accuracy.
    Primary Functions:
    1. Audit Customer Service contacts using the approved criteria and NCQA guidelines. Ability to identify contact which require immediate coaching, follow-up and or correction.
    2. Measure and evaluate individual performance with focus on customer service skills, accuracy and documentation of each contact type: inbound and outbound calls, external and internal emails, online chat and post contact surveys.
    3. Ability to conduct in-depth audits for multiple lines of business as well as focused audits for NCQA, Performance Guarantee Groups, Trainees, EOCCO/OHP.
    4. Handle multiple team and group assignments with different methods of contacts to audit and track daily.
    5. Exercise good judgment, initiative and discretion in confidential and sensitive manners,
    6. Evaluate audit results to identify trends and patterns, pinpoint issues and areas for improvement and recommend solutions and alternatives.
    7. Identify and forward examples of high quality calls and poor calls to leadership team.
    8. Transcribe calls and contacts as requested.
    9. Assist with external email inventory on multiple lines of business.
    10. Assist with post contact survey results and tracking.
    11. Compile, track and publish reports based on audit results and monitoring of contact types.  As well as track on a weekly, monthly and quarterly basis.
    12. Perform other duties as assigned.
    Together, we can be more. We can be better.

    Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

    For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.
  • 15 Days Ago

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Claims Adjuster I
  • Capital Claims Management, LLC.
  • Newberg, OR FULL_TIME
  • Claims Adjuster I – JOB AD Job Type: Full-time, In-Office Pay: $60,000 - $70,000 Who Are We? Capital Claims Management ("CCM") is a boutique insurance claims adjusting firm providing claims handling, ...
  • 1 Day Ago

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Audit/Tax Supervisor/Manager
  • NOVOCO
  • Springfield, OR FULL_TIME
  • Position Summary Novogradac & Company LLP is searching for a Manager to join our fast-growing firm. The Manager will manage a variety of tax, audit and other assignments as designated by the Principal...
  • 15 Days Ago

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Audit/Tax Supervisor/Manager
  • NOVOCO
  • Eugene, OR FULL_TIME
  • Position Summary Novogradac & Company LLP is searching for a Manager to join our fast-growing firm. The Manager will manage a variety of tax, audit and other assignments as designated by the Principal...
  • 1 Month Ago

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Audit/Tax Supervisor/Manager
  • NOVOCO
  • Medford, OR FULL_TIME
  • Position Summary Novogradac & Company LLP is searching for a Manager to join our fast-growing firm. The Manager will manage a variety of tax, audit and other assignments as designated by the Principal...
  • 1 Month Ago

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Audit/Tax Supervisor/Manager
  • NOVOCO
  • Bend, OR FULL_TIME
  • Position Summary Novogradac & Company LLP is searching for a Manager to join our fast-growing firm. The Manager will manage a variety of tax, audit and other assignments as designated by the Principal...
  • 1 Month Ago

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Quality Supervisor
  • Phoenix Services, LLC
  • Toledo, OH
  • Job Description Job Description Quality Manager needed for a growing company in Northwood, OH! You would be responsible ...
  • 3/28/2024 12:00:00 AM

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Quality Supervisor
  • Path Engineering
  • New Ulm, MN
  • Role As a Quality Supervisor (also known as Quality Assurance Supervisor, Quality Control Supervisor), you'll oversee an...
  • 3/28/2024 12:00:00 AM

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Quality Supervisor
  • KH Manufacturing - North America
  • New Ulm, MN
  • About Us The Kraft Heinz Company is one of the largest food and beverage companies in the world, with eight $1 billion+ ...
  • 3/28/2024 12:00:00 AM

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Quality Supervisor
  • The Judge Group
  • Charlotte, NC
  • Since 1869 we've connected people through food they love. Our history was created by remarkable people, ideas, and innov...
  • 3/28/2024 12:00:00 AM

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Quality Supervisor
  • The Judge Group
  • Knoxville, TN
  • The Judge Group is seeking a degreed Quality Assurance Supervisor in Knoxville, TN area! Responsibilities: Direct all QA...
  • 3/28/2024 12:00:00 AM

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Quality Supervisor
  • Kraft Heinz
  • Muscatine, IA
  • General information All posting locations: Muscatine, Iowa, United States of America Job Function: 07 - Quality Date Pub...
  • 3/27/2024 12:00:00 AM

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Quality Supervisor
  • Kraft Heinz Company
  • Muscatine, IA
  • Job Description Essential Functions & Responsibilities •Actively engaged support in planning, defining, and directing th...
  • 3/25/2024 12:00:00 AM

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Quality Supervisor
  • Kraft Heinz Company
  • Fremont, OH
  • Job Description Essential Functions & Responsibilities Actively engaged support in planning, defining, and directing the...
  • 3/24/2024 12:00:00 AM

Oregon (/ˈɒrɪɡən/ (listen) ORR-ih-gən) is a state in the Pacific Northwest region on the West Coast of the United States. The Columbia River delineates much of Oregon's northern boundary with Washington, while the Snake River delineates much of its eastern boundary with Idaho. The parallel 42° north delineates the southern boundary with California and Nevada. Oregon is one of only four states of the continental United States to have a coastline on the Pacific Ocean. Oregon was inhabited by many indigenous tribes before Western traders, explorers, and settlers arrived. An autonomous government ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Supervisor jobs
$72,642 to $91,029

Claims Quality Audit Supervisor in Provo, UT
Based on our compensation data, the estimated salary potential for Claims Quality Audit Supervisor will increase 16 % over 5 years.
January 29, 2020