- Managing provider reimbursement and analytics, claims quality analysts, claims compliance, training and remediation and user acceptance testing (UAT)
- Overseeing staffing and implementing and maintaining policies, procedures, and workflows across the Claims Department that is compliant with State and Federal Regulations
- Developing and enhancing reporting, monitoring performance, leveraging technology, tracking, and trending for multiple lines of business
- Coordination internal and external claims audit activities
- Collaborating with and supporting the Director of Claims Operations and Director of Program Integrity as needed to ensure the Claims Department is running at optimal performance
- Performing other duties, as needed
- 7+ years of Claims Operations experience in the Managed Care industry
- Bachelor's Degree
- Previous experience in a Leadership role
- Knowledge of Health Plan Claims industry regulations, guidelines, requirements, and policies including claims edit, coding and claims terminology.
- Working knowledge of Claims Processing, correspondence and CRM platforms and adjudication strategies
- Experience with Claims Testing / Auditing / QA
- Solid problem solving and time management skills
- Great interpersonal skills
- Excellent communication skills (written and verbal)
- Strong attention to detail
- Highly organized
- Master's Degree
- Claims Training experience
- Business Process Engineering experience
- Experience with multiple Health Plan Operational departments (i.e., configuration, medical management, provider operations, customer service, utilization management, regulatory, etc.)
-
Director of Claims Quality
1 week ago
Tandym Group Jersey City, United StatesA health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a ...
-
Director of Claims Quality
2 weeks ago
Tandym Group Jersey City, United StatesA health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a ...
-
Director of Claims Quality
6 days ago
MetroPlusHealth New York, United StatesJob Description · Job DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come ...
-
Claims Quality Analyst
6 days ago
MetroPlusHealth New York, United StatesJob Description · Job DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come ...
-
Director of Claims Quality
2 weeks ago
Tandym Group New York, United StatesA health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a ...
-
Claims Quality Analyst
6 days ago
MetroPlusHealth New York, United StatesJob DescriptionJob DescriptionEmpower. Unite. Care. · MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can com ...
-
Manager, Claims Quality
1 week ago
Oscar Health New York, United StatesJob Description · Job DescriptionHi, we're Oscar. We're hiring a Manager to join our Claims Quality team. · Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of ...
-
Quality Assurance Senior Claim Auditor
1 week ago
Chubb Jersey City, United StatesJob DescriptionPosition Overview: As a member of the Claims Quality Assurance and Compliance Team, a person in this position is responsible for supporting continuous improvement by measuring compliance in quality audits. Responsibilities also include partnering with various level ...
-
Director of Claims Quality Analytics
2 weeks ago
NYC Health Hospitals New York, United StatesMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchan ...
-
Claims Quality Control Analyst
2 weeks ago
Oscar Health New York, United StatesJob Description · Job DescriptionHi, we're Oscar. We're hiring a Claims Quality Control Analyst to join our Claims Quality team. · Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 201 ...
-
Director of Claims Quality
2 weeks ago
MetroPlus Health Plan Brooklyn, United StatesDirector of Claims Quality · Job Ref: 97369 · Category: Claims · Department: CLAIMS · Location: 50 Water Street, 7th Floor, · New York, · NY 10004 · Job Type: Regular · Employment Type: Full-Time · Hire In Rate: $150,000.00 · Salary Range: $150, $170,000.00 · Empower. U ...
-
Avp, Claim Manager
2 weeks ago
Berkley Jersey City, United StatesCompany Details: · W. R. Berkley Corporation, founded in 1967, is one of the nation's premier commercial lines property casualty insurance providers. Founded in 2004, Berkley Environmental has underwriting and account executive units in seven regions. Berkley Environmental offers ...
-
Claims Director, Westchester Specialty
2 weeks ago
Combined Insurance Jersey City, United StatesThis is a hybrid position: 3 days in the office, 2 days remote per week. · **Scope** · The Westchester Casualty Claims Director is responsible for investigating and settling high exposure, high risk claims. Ensure high level of customer service and claim file quality. · Duties in ...
-
Relocation Specialist
2 weeks ago
TranSystems Corporation Jersey City, United StatesOverview: · We are excited to share once again TranSystems has been recognized as a top 100 design firm by Engineering News-Record in 2024. TranSystems is committed to building strong relationships with our clients, partners, and communities, because we believe we can go farther ...
-
Director of Nursing
1 week ago
Constructive Partnerships Unlimited Hudson, United States**Job Brief**: · Provides supervision, training and guidance to the nurse case managers/Day Program nurses within the borough. · - Shift Worked: · **Varied** · - Weekly Hours: · **37.5** · - FLSA Status: · **Exempt** · - Pay range: · **$120,000-$120,000** · ***: · Provides superv ...
-
Underwriter, Financial Lines
6 days ago
Liberty Mutual Manhattan, United States**Pay Philosophy** · The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in the ...
-
Assistant Director
2 weeks ago
NYC Health + Hospitals New York, United States**About NYC Health + Hospitals**: · **Empower Every New Yorker — Without Exception — to Live the Healthiest Life Possible** · **NYC Health + Hospitals** is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based servic ...
-
Executive Director
1 week ago
NYC Careers Manhattan, United States**Executive Director - Fiscal Affairs**: · - Apply**Executive Director - Fiscal Affairs**: · - Agency: DEPARTMENT OF TRANSPORTATION · - Posted on: 04/19/2024- Job type: Full-time · Location · MANHATTAN · - Title Classification: Exam may be required · Department · Fiscal Affairs · ...
-
Pharmacy Technician
1 week ago
Meds New York, United StatesWe are Meds, the pharmacy of the future. We are not just a pharmacy, we're a tech company. With technology, we are rebuilding how pharmacy operations work. We do more than just fill prescriptions. We are a team of highly motivated individuals that work hand in hand in a coordinat ...
-
Fabric Production Converter
5 days ago
Zelouf International Corp New York, United States**Job Title**: Fabric Production Converter · **Exemption Status**: Exempt · **Reports to**:Production Manager · **Work Schedule**: Monday - Friday (On-site) · **Role Summary**: · The Production Converter role performs multiple tasks related to purchasing, production processing an ...
Director of Claims Quality - Jersey City, United States - Tandym Group
Description
A health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance oversight program to ensure payment accuracy.
Responsibilities:
The Director of Claims Quality will be responsible for:
Qualifications:
Desired Skills:
