Claims Quality Manager

ROI Search Group - Indianapolis, IN

ROI Search Group is an executive recruiting and consulting firm based in Indianapolis with work nationwide. With a belief that people are an organization’s most important asset, the approach to both company and candidate screening to acquire the most qualified talent in the life science and healthcare sector is unique by design. Drawing upon seasoned experience, ROISG’s proprietary methods provide a better understanding of client goals, job requirements and company culture.

Our client is in search of a high-performing and successful Manager, Claims Quality that is interested in career progression. This role will oversee the daily operations of the Claims Quality Team. The team is responsible for claims analysis including financial and procedural accuracy, personnel production, compliance and statistical results.

Responsibilities include but not limited to:

  • Manages the team and complex claims adjudication quality and vendor production assignments. Leads workforce planning for the team.
  • Oversees claims analysis, including financial/procedural accuracy, team member production, and compliance/statistical results.
  • Identifies any potential process issues or inconsistencies and manages improvements and/or escalates issues as needed.
  • Established and implements the strategic planning, program development, labor and overall management for areas of claims quality operations.
  • Provides professional guidance to internal and external customers.
  • Assists in the development/implementation of goals, policies, and procedures.

Requirements:

  • Bachelors’ degree from an accredited program in business, healthcare or related field.
  • Minimum of 5 years of experience in claims operations or a related field.
  • Experience with Commercial claims analysis is a must, experience with Medicare claims analysis is preferred.
  • A strong understanding of coordination of benefits and reinsurance is required.
  • Coding knowledge of HCPCS, ICD-10, CPT-4, DRG & APC Pricing required.
  • CPC or CCA certification preferred.


Posted On: Thursday, November 8, 2018



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