Claims Quality Assurance Supervisor

WelbeHealth

1d•$99,310 - $131,089

About The Position

The Claims Quality Assurance Supervisor develops and oversees a team of para-professional team members to ensure claims are processed accurately and efficiently and comply with contractual and regulatory requirements on a pre- and post-payment basis. As a member of WelbeHealth’s management team, the supervisor builds collaborative relationships across the organization and with external stakeholders while promoting the company’s values, team culture, and mission. The role leads claims quality assurance strategy and execution, including accurate and timely claims payments and compliance with Medicare, Medicaid, contractual, and regulatory requirements. It also drives continuous improvement through data-driven auditing, trend analysis, cross-functional collaboration, team development, workflow improvements, and quality standards. Compensation consists of base salary plus bonus. The listed compensation range is $99,309.58–$131,088.64 USD; actual compensation depends on experience and relevant qualifications. WelbeHealth requires employees to provide proof of vaccination or a vaccine declination form before employment and maintains infection-control and PPE standards.

Requirements

Associate degree preferred, or relevant professional experience in a health plan environment emphasizing billing, claims payment, coding, or closely related functions may be substituted.
Minimum of five years of experience in health plans, such as managed care or PACE, strongly preferred.
Experience in a claims processing environment, with an emphasis on claims auditing.
Progressively responsible experience and demonstrated ability to mentor team members.
Working knowledge of Medicare and/or Medicaid billing and guidelines.
Ability to understand and analyze contractual and regulatory requirements and their effect on claims payment and resolutions.
Ability to process accurate information in a timely manner.
Excellent leadership, organizational, and communication skills.
Experience leading in a data-driven organization and using reports and data to prioritize and manage people and projects.
Comprehensive knowledge of claims processing and regulations, strong problem-solving skills, and the ability to analyze problems and formulate solutions.

Nice To Haves

Associate degree.
Five or more years of experience in health plans, such as managed care or PACE.

Responsibilities

Oversee audits to ensure claims are paid accurately and promptly in accordance with internal and external regulations and guidelines.
Identify issues and operational gaps, develop solutions, and recommend improvements to processing and training.
Track progress and regularly communicate audit results and status to affected parties.
Recommend improvements based on identified trends and work with management and other departments to implement changes as directed.
Create and update team procedures, workflows, and resource materials.
Monitor daily team member activities and report critical issues or concerns to management.
Serve as the primary resource and escalation point for quality assurance issues.
Directly supervise, support, and guide team members.
Evaluate team member performance and provide feedback, coaching, and counseling when performance issues arise.
Identify training gaps and opportunities to improve performance.
Develop and execute claims quality assurance strategy, using data-driven audits and trend analysis to improve workflows and claims quality.