Senior Claims Quality Lead - Audit & Compliance

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

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.