Claims Quality Director

3 days ago


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

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


  • New York, New York, United States Momentum Resource Solutions Full time

    About UsMomentum Resource Solutions is a leading provider of claims processing services, dedicated to delivering high-quality solutions to our clients. We are committed to excellence and strive to create a workplace that fosters collaboration and innovation.We offer competitive salaries, comprehensive benefits, and opportunities for growth and development....


  • New York, New York, United States Momentum Resource Solutions Full time

    **About Momentum Resource Solutions:**Momentum Resource Solutions is a leading provider of innovative staffing solutions.We are seeking an experienced professional to join our team as a **Director of Claims Quality** in our New York City office.


  • New York, New York, United States Ascot Group Full time

    The Ascot Group seeks a seasoned claims management professional to oversee Third-Party Administrators (TPAs) handling commercial casualty, auto, property, inland and ocean marine, and E&O claims. As Claims Manager Director, you will be responsible for providing strategic direction for Ascot's programs and captives, collaborating with internal and external...


  • New York, New York, United States Momentum Resource Solutions Full time

    About the Role:We are looking for a highly skilled and results-driven Director of Claims Quality to join our team at Momentum Resource Solutions. As a key member of our leadership team, you will be responsible for developing and implementing a data-driven claims quality assurance program to ensure payment accuracy and promote a culture of continuous...


  • New York, New York, United States Momentum Resource Solutions Full time

    Job DescriptionMomentum Resource Solutions is seeking a highly skilled Quality Assurance Director to lead our Claims Quality team. This is a full-time role with an estimated annual salary of $120,000-$160,000 based on experience.About the RoleWe are looking for a seasoned professional to develop and implement a data-driven quality assurance program that...


  • New York, New York, United States American International Group Full time

    Key ResponsibilitiesAs a Complex Claims Director for Financial Institutions, your primary focus will be on handling all aspects of complex claims against financial institutions, including Errors & Omissions, Directors & Officers claims, Fiduciary and EPL claims. You will also be responsible for making case presentations, setting judgmental reserves,...


  • New York, New York, United States Momentum Resource Solutions Full time

    Job Overview:Momentum Resource Solutions is seeking an experienced Director of Claims Quality to lead our claims operations team. This role is a great opportunity for a motivated individual to drive excellence in claims quality and process improvement.


  • New York, New York, United States MetroPlusHealth Full time

    MetroPlusHealth is a leading healthcare provider in New York, dedicated to empowering individuals and communities through quality care.About MetroPlusHealthWe believe that healthcare is a right, not a privilege. Our commitment to excellence has earned us a reputation for providing exceptional service and comprehensive coverage to residents of Bronx,...


  • New York, New York, United States MetroPlusHealth Full time

    Empower Your Career with MetroPlusHealthMetroPlusHealth is a leading healthcare provider dedicated to empowering New Yorkers through quality care. As a Claims Quality Assurance Specialist, you will play a vital role in ensuring the accuracy and integrity of our claims processing system.About Us:We provide comprehensive healthcare services to residents of...


  • New York, New York, United States Momentum Resource Solutions Full time

    Job DescriptionMomentum 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...


  • New York, New York, United States Ascot Group Full time

    Job Description:At Ascot Group, we're seeking a highly experienced Vice President, Claims TPA Manager to lead our Third-Party Administrator (TPA) management team. This role involves providing strategic direction for our programs and captives, collaborating with internal and external partners on TPA management and claims operations.Key Responsibilities:Lead...


  • New York, New York, United States Momentum Resource Solutions Full time

    Job Description:The Director of Claims Quality will oversee the creation, delivery, and facilitation of a metrics-driven claims quality assurance and performance oversight program. This includes defining frameworks and benchmarks, calibrating and reporting on program progress, and promoting a culture of continuous improvement. Additionally, this role...


  • New York, New York, United States Argo Group Full time

    About the PositionWe are seeking an Executive Director of Property and Casualty Claims to join our team at Argo Group. As a leader in specialty insurance, we pride ourselves on providing innovative solutions to complex problems.This is a challenging and impactful role that will have a significant effect on our bottom-line results. The successful candidate...


  • New York, New York, United States Claims Conference Full time

    Job OverviewThe Claims Conference seeks a detail-oriented and proactive individual to support our Research, Education, and Documentation (RED) team in New York. This role involves overseeing a portfolio of grants, reviewing funding proposals, and collaborating on projects and initiatives.Salary and BenefitsThe estimated salary range for this position is...


  • New York, New York, United States Restaurant Associates Full time

    The Quality Assurance Director for Restaurant Associates is a key leader of our Operations Excellence team, responsible for the success of our food and physical safety programs.Job ResponsibilitiesOversee all Food and Workplace Safety Initiatives at the sector levelCoordinate and monitor safety training at the sector level (Daily, Monthly, Quarterly, and...


  • New York, New York, United States Berkshire Hathaway Specialty Insurance Full time

    Berkshire Hathaway Specialty Insurance is seeking a highly skilled Complex Claims Director to join our team. As a key member of our claims team, you will play a critical role in handling complex claims, working closely with internal partners, and collaborating with external stakeholders.ResponsibilitiesEvaluate complex claims data to determine exposure and...


  • New York, New York, United States American Cybersystems Full time

    At American Cybersystems, we are seeking a skilled Claims User Acceptance Tester to join our team. As a key member of our quality assurance team, you will be responsible for ensuring that our solutions meet business requirements for successful project delivery.About the RoleWe are looking for a highly motivated and experienced individual to lead and...


  • New York, New York, United States MetroPlus Health Plan Full time

    **About MetroPlusHealth**MetroPlusHealth is a leading healthcare provider committed to empowering New Yorkers by uniting communities through care. Our mission is rooted in the belief that health care is a right, not a privilege.We are seeking a highly skilled Claims User Acceptance Quality Assurance Specialist to join our team. This individual will play a...


  • New York, New York, United States Icahn School of Medicine at Mount Sinai Full time

    About the RoleThe Icahn School of Medicine at Mount Sinai invites applications for a Procedural Claims Expert to join their team. This is a senior-level position responsible for managing multiple components of the billing process for specialized or complex pre and post-surgical procedures.The ideal candidate will have experience in medical billing, health...


  • New York, New York, United States MetroPlus Health Plan Full time

    Job DescriptionThe ideal candidate will be responsible for validating business requirements before releasing a product to production. This role involves performing positive and negative testing to identify defects, ensuring they are corrected prior to implementation.As a subject matter expert for Claims operations system applications, you will maintain...