Lead, Medical Coding & Claims Quality

PacificSource; Boise, Northern (ID, KY); Hybrid; USD 65,000 - 111,000; Full time

Benefits offered by this job

Flexible telecommute policy

Medical, vision, and dental insurance

401(k) plan

Paid time off and holidays

Job summary

PacificSource is seeking a Claim Audit Manager to supervise the Claims Audit team, ensuring production and quality standards across lines of business. You will resolve adjudication issues, collaborate with Grievance and Appeals, and coach staff to achieve organizational goals.

Preferred candidates have 4+ years in complex claims management, supervisory experience, and familiarity with self-funded plans. Travel is modest and leadership is prioritized.

Qualifications

• Minimum of 4 years of complex claims management experience including auditing, billing, research, and recovery.
• At least 1 year of supervisory experience required.
• Experience in self-funded claims administration preferred.

Responsibilities

• Supervise and lead the Claims Audit team to ensure production and quality standards.
• Oversee fraud, waste, and abuse claim reviews and complex claims research with Compliance.
• Collaborate with Grievance and Appeals to determine appropriate claims outcomes.
• Prepare reports and communicate process changes to team and stakeholders.

Skills

Accountable leadership

Collaboration

Communication

Critical Thinking

Decision Making

Influencing

Listening

Organizational skills

Education

High school diploma or equivalent

Tools

Microsoft Word

Excel

Job description

PacificSource is seeking a Claim Audit Manager to supervise the Claims Audit team, ensuring production and quality standards across lines of business. You will resolve adjudication issues, collaborate with Grievance and Appeals, and coach staff to achieve organizational goals.

Preferred candidates have 4+ years in complex claims management, supervisory experience, and familiarity with self-funded plans. Travel is modest and leadership is prioritized.