Claims Quality Assurance and Compliance Specialist - Alpharetta, United States - Westfield

    Westfield
    Westfield Alpharetta, United States

    1 month ago

    Show more Collapse job
    Default job background
    Description


    Job DescriptionWe are seeking a detail-oriented and analytical individual to join our team as a Specialty Claims Quality Assurance and Compliance Specialist.

    This role will report to the VP, Specialty Claims Compliance. You will be responsible for ensuring that insurance claims processes adhere to regulatory requirements and internal quality standards.

    The ideal candidate will possess strong analytical skills, attention to detail, and a comprehensive understanding of Specialty insurance claims best practices, procedures and compliance regulations.


    ResponsibilitiesWhat you will do:
    Assist in the implementation of a QA platform for auditing, reporting and the tracking of action plans. Review Specialty insurance claims documentation and processes to ensure accuracy, completeness, and compliance with established standards and best practices. Conduct audits and analysis of claims data to identify trends, discrepancies, and areas for improvement. Collaborate with cross-functional teams to resolve quality issues. Develop and deliver compliance training programs for claims processing staff on regulatory requirements and best practices. Stay informed about changes in regulatory requirements, industry trends, and best practices. Ensure internal claims adjusters are properly licensed. Prepare comprehensive reports on quality assurance and compliance activities, highlighting areas for improvement and compliance status. Identify opportunities for process optimization and efficiency gains within claims processing workflows.


    QualificationsWhat you need to have:
    Five to seven years of experience in insurance claims management, compliance, or similar role within insurance. Strong knowledge of specialty lines of insurance, insurance regulations, and relevant state and federal laws. Strong analytical skills with the ability to interpret complex data and identify trends. Attention to detail and accuracy in documentation and analysis. Proficiency in Microsoft Office Suite and claims process software. Exceptional communication and interpersonal skills, with the ability to collaborate effectively across departments. Professional certification in insurance, compliance, or a related field is preferred. Ability and willingness to travel as needed.#wsp

    We have other current jobs related to this field that you can find below

  • Saddle Rock Legal Group

    Audit and Compliance Specialist

    1 week ago

    Saddle Rock Legal Group Sandy, United States

    Are you detail-oriented and passionate about ensuring legal and regulatory requirements are met? If so, we have an exciting opportunity for you to join our team as a full-time Audit and Compliance Specialist at Saddle Rock Legal Group in Draper, UT. This auditor position offers a ...

  • Stantec

    EHS Compliance Specialist

    3 weeks ago

    Stantec Alpharetta, United States

    EHS Compliance Specialist M ) · Description · Grounded in safety, quality, and ethics, our experts lead their fields and guide our work with rigor, a creative spirit, and vision for growth. We draw from more than 20 technical specialties around the globe and are committed to fost ...

  • Wheels

    Compliance Service Specialist II

    2 days ago

    Wheels Alpharetta, United States

    Job Description: · JOB OVERVIEW · The Compliance Services Specialist II position manages various transactional roles within the Compliance Services team including processing of new vehicle paperwork or annual registration renewals for vehicles managed by Wheels fleet management c ...

  • GeorgiaGov

    Safety & Compliance Specialist 2 (Statewide)

    1 week ago

    GeorgiaGov Georgia, United States

    Under supervision, the Building Code Inspector (Safety Fire - Inspections) performs inspections for compliance with policy, procedures, state and federal regulations, and standards to ensure safety and compliance. · Gains knowledge of changes in state, OSHA, NFPA, and other safet ...

  • DeKalb County School District

    Contract Specialist II, Captial, Projects

    4 days ago

    DeKalb County School District Georgia, United States

    The DeKalb County School District is seeking an experienced and professional Contract Compliance, Specialist II. · Salary Grade/Schedule: Unified · Salary Schedules: · The material contained herein is subject to change. All open positions offered by the DeKalb County School Dis ...

  • Prestige Staffing

    Sr. HR Benefits Specialist

    1 week ago

    Prestige Staffing Alpharetta, United States

    Sr. HR Benefits Specialist - Permanent position in Alpharetta, GA · Hybrid - 3 days onsite (T,W,TH) 2 days remote (M,F) · Salary Range: Up to $64K + 401K and contributions to Savings / Retirement Plans · Client would like to see candidates that have a Spiritual Christian Walk ...

  • The Intersect Group

    Customer Account Specialist

    1 day ago

    The Intersect Group Sandy Springs, United States

    We are currently partnered with a great company for a Customer Account Specialist position This is a perfect opportunity to gain quality experience in a large company · Responsibilities of the Customer Account Specialist · Identify and escalate possible process improvement ideas ...

  • DeKalb County School District

    Specialist I, Claims and Revenue

    4 days ago

    DeKalb County School District Georgia, United States

    DeKalb County School District is seeking a motivated and experienced Specialist I, Claims & Revenue. · Salary Grade/Schedule: · Salary Schedules: · The material contained herein is subject to change. All open positions offered by the DeKalb County School District are subject to ...

  • Brave Health

    Quality Assurance Specialist

    3 weeks ago

    Brave Health Georgia, United States

    About Us · Brave Health is on a mission to expand access to high-quality, affordable care for behavioral health conditions. We utilize the power of technology to eliminate barriers and expand access to high quality mental health and substance use disorder treatment. Through teleh ...

  • Quest Financial

    Loan Closing Specialist

    19 hours ago

    Quest Financial Alpharetta, United States

    Our client located in Alpharetta, GA is looking for a Consumer Lending Closing Specialist to join their team · Pay: $55k - $65k · In office, M-F · Medical, Dental · The Consumer Lending Closing Specialist will be responsible for documenting, auditing, and monitoring the consumer ...

  • Ascendo Resources

    Document Reviewer

    2 weeks ago

    Ascendo Resources Georgia, United States

    This opportunity is open to remote work in the following approved states: AL, AK, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL, PA, TX and WI, in-office and ...

  • GSI

    Sales Operations Specialist

    1 week ago

    GSI Sandy Springs, United States

    Job Title: Sales Operations Specialist · An international medical company is hiring a Business Sales Analyst to join its dynamic contracts and sales team. In this role, you will support the sales organization with pricing proposals, predictive spending analysis, and day-to-day ac ...

  • GSI

    Sales Operations Specialist

    4 days ago

    GSI Sandy Springs, United States

    Job Title: Sales Operations Specialist · Global Medical Device Company · An international medical company is hiring a Business Sales Analyst to join its dynamic contracts and sales team. In this role, you will support the sales organization with pricing proposals, predictive spen ...

  • Bank OZK

    Consumer Loan Specialist II

    2 weeks ago

    Bank OZK Alpharetta, United States Full time Regular

    Position Description: · Job Purpose and Scope: · As the primary point of contact in the consumer loan process, the Consumer Loan Specialist is responsible for educating the applicants(s) on the Bank's loan products and ensuring a complete and compliant loan application. The Con ...

  • GeorgiaGov

    Construction Management Engineer

    1 week ago

    GeorgiaGov Georgia, United States

    TRP051, Transportation Specialist 2 (L) · "Construction Management Engineer (CME)" · Job Salary: $62,000 · Job Specific Duties: Under general supervision, manages highway construction activities in an assigned geographical area or on multiple moderate to highly complex proj ...

  • Synovus Financial

    AML/BSA Investigator II

    3 days ago

    Synovus Financial Georgia, United States Full time

    Job Description · Job Summary · Identifies and investigates suspicious activity in support and fulfillment of Anti-Money-Laundering/Bank Secrecy Act (AML/BSA) regulatory requirements. Analyzes customer account transactions to detect suspicious activity and decides on appropriat ...

  • DeKalb County School District

    MTSS Specialist

    4 days ago

    DeKalb County School District Georgia, United States

    Columbia High School is seeking an experienced and professional Multi-Tiered System of Support Specialist (MTSS). · Salary Grade/Schedule: E · Salary Schedules: · The material contained herein is subject to change. All open positions offered by the DeKalb County School District ...

  • DeKalb County School District

    MTSS Specialist

    3 weeks ago

    DeKalb County School District Georgia, United States

    McNair High School is seeking an experienced and professional Multi-Tiered System of Support Specialist (MTSS). · Salary Grade/Schedule: E · Salary Schedules: · The material contained herein is subject to change. All open positions offered by the DeKalb County School District ar ...

  • SAP

    Digital Deal Strategy Specialist

    4 days ago

    SAP Alpharetta, United States

    We help the world run better · At SAP, we enable you to bring out your best. Our company culture is focused on collaboration and a shared passion to help the world run better. How? We focus every day on building the foundation for tomorrow and creating a workplace that embraces ...

  • GeorgiaGov

    Medical Coding Adjunct Instructor

    1 week ago

    GeorgiaGov Georgia, United States

    Nature of Duties: Under general supervision prepares lesson plans for classroom instruction for credited technical/occupational courses; prepares standardized course syllabi using a provided template; evaluates students' progress in attaining goals and objectives based on establi ...