Head of Claims Assurance

3 weeks ago


New York, New York, United States Momentum Resource Solutions Full time
Job Description

Momentum Resource Solutions is seeking an experienced Claims Quality Director to lead our Claims department. The successful candidate will be responsible for driving quality assurance and performance oversight programs, ensuring payment accuracy, and promoting a culture of continuous improvement.

The ideal candidate will have a strong background in claims operations, with at least 7-10 years of experience in the managed care industry and 3 years in a leadership role. A Master's Degree is preferred.

We estimate the salary for this position to be around $120,000 - $150,000 per year, depending on location and qualifications.

About the Role:

The Claims Quality Director will oversee the creation, delivery, and facilitation of data-driven quality assurance and performance oversight programs. This includes defining frameworks, calibration, and reporting of benchmarks to ensure payment accuracy.

The successful candidate will also manage the benchmark process from start to finish, ensuring consistent reviews and developing quality and performance improvement plans.

The job involves tracking remediation plans through completion, managing provider reimbursement and analytics teams, and creating insightful stakeholder reports.

Key Responsibilities:

  • Create, deliver, and facilitate data-driven quality assurance and performance oversight programs
  • Manage the benchmark process from start to finish
  • Track remediation plans through completion
  • Manage provider reimbursement and analytics teams
  • Develop insightful stakeholder reports
  • Promote a culture of continuous improvement

Requirements:

  • Bachelor's Degree required; Master's Degree preferred
  • At least 7-10 years of claims operations experience in the managed care industry
  • Minimum of 3 years in a leadership role
  • Experience with multiple health plan operational departments a plus


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