Director of Claims Quality Management

4 weeks ago


Brooklyn, New York, United States MetroPlus Health Plan Full time
Job Title: Director of Claims Quality Management

At MetroPlus Health Plan, we are seeking a highly skilled and experienced Director of Claims Quality Management to join our team. This is a critical role that will oversee the development and implementation of our claims quality management program, ensuring that our claims processing meets the highest standards of quality and compliance.

The successful candidate will have a strong background in claims operations, quality assurance, and compliance, with a proven track record of driving process improvements and reducing errors. They will be responsible for developing and implementing policies, procedures, and workflows to ensure that our claims processing meets regulatory requirements and industry standards.

The Director of Claims Quality Management will also be responsible for leading a team of quality assurance specialists and working closely with our claims operations team to ensure that our claims processing is accurate, efficient, and compliant.

Key Responsibilities:

  • Develop and implement a claims quality management program that meets regulatory requirements and industry standards
  • Lead a team of quality assurance specialists to ensure that claims processing meets quality and compliance standards
  • Work closely with the claims operations team to ensure that claims processing is accurate, efficient, and compliant
  • Develop and implement policies, procedures, and workflows to ensure compliance with regulatory requirements and industry standards
  • Conduct regular audits and reviews to ensure that claims processing meets quality and compliance standards

Requirements:

  • Bachelor's degree in a related field (e.g. healthcare administration, business administration)
  • 7-10 years of experience in claims operations, quality assurance, and compliance
  • Proven track record of driving process improvements and reducing errors
  • Strong knowledge of regulatory requirements and industry standards
  • Excellent leadership and communication skills

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