Claims Quality Supervisor

University of California - Los Angeles Health; Los Angeles (CA); On-site; USD 79,000 - 164,000; Full time

Job summary

University of California - Los Angeles Health is seeking a detail-oriented Claims Quality Supervisor to lead audit and quality assurance initiatives across all aspects of claims operations. This role ensures accuracy, efficiency, and regulatory compliance.

You will develop QA monitoring systems, oversee audit programs, manage customer service within Claims Administration, and mentor staff to meet service goals and performance objectives.

Qualifications

• 5+ years of claims experience in a managed care environment.
• 2+ years of supervising staff.
• Thorough knowledge of claims processing and regulations.
• Strong problem solving and analytical abilities.
• Ability to manage multiple complex tasks and priorities.
• Proficient with Microsoft Word, Excel, Access and Diamond or similar systems.

Responsibilities

• Develop and implement internal quality assurance monitoring systems and reporting tools.
• Oversee audit programs to maintain high standards of compliance and performance.
• Manage the customer service functions within the Claims Administration Department.
• Lead and staffing the customer service team to meet established service goals and performance objectives.
• Provide direct supervision and guidance for Quality Control and Customer Service staff and provide developmental and training opportunities for team members.

Skills

Claims experience

Staff supervision

Regulatory knowledge

Problem solving

Tools

Diamond

Job description

Description

We are seeking a detail-oriented and experienced Claims Quality Supervisor to lead our audit and quality assurance initiatives across all aspects of claims operations. This role is responsible for ensuring accuracy, efficiency, and compliance with contractual and regulatory requirements.

Key responsibilities include:

• Developing and implementing internal quality assurance monitoring systems and reporting tools.
• Overseeing audit programs to maintain high standards of compliance and performance.
• Managing the customer service functions within the Claims Administration Department.
• Leading and staffing the customer service team to meet established service goals and performance objectives.
• Provide direct supervision and guidance for Quality Control and Customer Service staff and provide developmental and training opportunities for team members.

Salary Range: $78,500 - $163,600/Annually

Qualifications

• Minimum of 5 years claims experience in a managed care environment required
• Minimum of 2 years' experience in supervising staff required
• Must have comprehensive knowledge of claims processing and regulations.
• Must have strong ability to problem solving skills. Ability to analyze problems and formulate plans, solutions and a course of action.
• Ability to successfully execute many complex tasks simultaneously.
• Ability to set own priorities and to work as a team member as well as independently.
• Ability to perform comfortably in a fast paced, deadline-oriented work environment.
• Proficient computer skills in Internet search capabilities, Microsoft Word, Excel, Access and Managed Care software (i.e. Diamond).
• Thorough knowledge of health care industry, benefit plans, contracts and flow of related information.
• Knowledge of professional and facility provider reimbursement/contracting methodologies.
• Excellent interpersonal and verbal/written communication skills. Effective presentation skills.
• Ability to maintain confidentiality of patient and business records.
• Ability to work Business hours