Claims Quality Audit Director jobs in New York, NY

Claims Quality Audit Director directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Provides professional knowledge and guidance on technical or procedural problems. Being a Claims Quality Audit Director creates claims audit policies and procedures. May recommend changes in claims processing procedures. Additionally, Claims Quality Audit Director typically Requires a bachelor's degree. Typically reports to top management. The Claims Quality Audit Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Quality Audit Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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Director of Claims Quality
  • The Tandym Group
  • New York, NY FULL_TIME
  • A health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance oversight program to ensure payment accuracy.

    Responsibilities:

    The Director of Claims Quality will be responsible for:
    • Managing provider reimbursement and analytics, claims quality analysts, claims compliance, training and remediation and user acceptance testing (UAT)
    • Overseeing staffing and implementing and maintaining policies, procedures, and workflows across the Claims Department that is compliant with State and Federal Regulations
    • Developing and enhancing reporting, monitoring performance, leveraging technology, tracking, and trending for multiple lines of business
    • Coordination internal and external claims audit activities
    • Collaborating with and supporting the Director of Claims Operations and Director of Program Integrity as needed to ensure the Claims Department is running at optimal performance
    • Performing other duties, as needed
    Qualifications:
    • 7 years of Claims Operations experience in the Managed Care industry
    • Bachelor’s Degree
    • Previous experience in a Leadership role
    • Knowledge of Health Plan Claims industry regulations, guidelines, requirements, and policies including claims edit, coding and claims terminology.
    • Working knowledge of Claims Processing, correspondence and CRM platforms and adjudication strategies
    • Experience with Claims Testing / Auditing / QA
    • Solid problem solving and time management skills
    • Great interpersonal skills
    • Excellent communication skills (written and verbal)
    • Strong attention to detail
    • Highly organized
    Desired Skills:
    • Master's Degree
    • Claims Training experience
    • Business Process Engineering experience
    • Experience with multiple Health Plan Operational departments (i.e., configuration, medical management, provider operations, customer service, utilization  management, regulatory, etc.)
  • 30 Days Ago

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Director of Claims Quality
  • MetroPlus Health Plan
  • New York, NY FULL_TIME
  • Director of Claims Quality Job Ref: 97369 Category: Claims Department: CLAIMS Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Hire In Rate: $150,0...
  • 12 Days Ago

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Research and Program Support Center, Director
  • International Foundation for Ethics and Audit
  • New York, NY FULL_TIME
  • The InitiativeThe Research and Program Support Center is a new investment being pursued by the International Auditing and Assurance Standards Board (IAASB) and the International Ethics Board for Accou...
  • 29 Days Ago

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Internal Audit Director - Internal Operations & Quality Control
  • Morgan Stanley
  • New York, NY FULL_TIME
  • We are seeking a Director to join our Internal Audit Regulatory Relations team. The successful candidate will be a member of the Audit department and will help ensure that regulatory requirements are ...
  • 24 Days Ago

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Audit Director - Quality Assurance - Regulatory Issue Validation - Risk/Treasury
  • Hispanic Technology Executive Council
  • New York, NY FULL_TIME
  • Citi's Internal Audit (IA) division provides independent assessments of the company's governance, risk management and internal control environment for key stakeholders including the Board of Directors...
  • 21 Days Ago

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Claims Director
  • Everest National Insurance Company
  • New York, NY FULL_TIME
  • Title: Claims Director Company: Everest Insurance Company Job Category: Claims Job Description: Everest is a leading global reinsurance and insurance provider, operating for nearly 50 years through su...
  • 2 Days Ago

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0 Claims Quality Audit Director jobs found in New York, NY area

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RN Director of Quality and Performance Improvement - Home Health Care
  • Compass Healthcare Consulting & Placement
  • New York, NY
  • Job Description Job Description Compass Healthcare Consulting & Placement is conducting a search for an experienced Dire...
  • 4/27/2024 12:00:00 AM

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Director of Quality Initiatives
  • NYC Health + Hospitals/Correctional Health Services
  • New York, NY
  • NYC Health + Hospitals is the largest public health care system in the nation. We are a network of 11 hospitals, trauma ...
  • 4/26/2024 12:00:00 AM

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Director of Quality Assurance - New York
  • Galaxy Digital
  • New York, NY
  • Who You Are: As the Director of Quality Assurance, you will play a crucial role in maintaining and enhancing the quality...
  • 4/26/2024 12:00:00 AM

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Director of Quality Initiatives
  • Nyc Health + Hospitals/correctional Health Services
  • New York, NY
  • NYC Health + Hospitals is the largest public health care system in the nation. We are a network of 11 hospitals, trauma ...
  • 4/25/2024 12:00:00 AM

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Director of Quality Assurance - New York
  • Galaxy
  • New York, NY
  • Who We Are: At Galaxy we are building products and services to help the world invest in economic progress. We believe cr...
  • 4/25/2024 12:00:00 AM

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Director of Quality Initiatives
  • NYC Health + Hospitals/Correctional Health Services
  • New York, NY
  • NYC Health + Hospitals is the largest public health care system in the nation. We are a network of 11 hospitals, trauma ...
  • 4/24/2024 12:00:00 AM

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Director of Quality
  • Horizon Group USA, Inc.
  • Warren, NJ
  • Job Description Job Description Please note, this role is based on a hybrid capacity from our Warren, NJ office and will...
  • 4/23/2024 12:00:00 AM

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Director Water Quality
  • Veolia
  • Nyack, NY
  • Job Details Company Description About Veolia North America A subsidiary of Veolia Group, Veolia North America (VNA) offe...
  • 4/23/2024 12:00:00 AM

The City of New York, usually called either New York City (NYC) or simply New York (NY), is the most populous city in the United States. With an estimated 2017 population of 8,622,698 distributed over a land area of about 302.6 square miles (784 km2), New York is also the most densely populated major city in the United States. Located at the southern tip of the state of New York, the city is the center of the New York metropolitan area, the largest metropolitan area in the world by urban landmass and one of the world's most populous megacities, with an estimated 20,320,876 people in its 2017 M...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Director jobs
$177,076 to $253,065
New York, New York area prices
were up 1.6% from a year ago

Claims Quality Audit Director in Olympia, WA
Based on our compensation data, the estimated salary potential for Claims Quality Audit Director will increase 16 % over 5 years.
December 23, 2019