Claims Quality Audit Manager jobs in Newark, NJ

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

• Oversee the management of respective databases to ensure data is updated and any maintenance requirements are being reviewed.
• Development and execution of coaching plans on a monthly and quarterly basis based on on data analysis from speech analytics, audit findings, and/or AHT outlier reports.
• May develop, administer and monitor coaching activities for all divisional new hire and existing employees as well as the offsite vendor partners.
• Identify training and development needs through trending analysis, business partner requirements and service initiatives partner with Training and Development to share results.
• Develop and support business partnerships and represent department/enterprise with internal customers and vendor partners where appropriate.
• Conduct detailed analysis to determine root cause analysis in connection with deficiencies sited in Audits, speech analytics or AHT data; develop and implement corrections.
• Design/implement audit plan for new audits.
• Ensure Service Level Agreements (SLAs) are followed both internally and with vendors, educate vendors on policies & practices, monitor vendor compliance.
• Identify, communicate and implement Best Practices across the enterprise as well as new audit initiatives, process improvements and any other observations discovered during the audit process, speech analytics or AHT data which may impact the Service Division.
• Present to stakeholders recommendations and enhancements of underlying processes to improve company performance based on data analysis from speech analytics, audit findings, and/or AHT outlier reports.
• Oversee external audits by government regulators to ensure accuracy of findings.
• Accountable for maintaining effective internal controls over the processes and transactions under areas of responsibility including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.

Education:

• Bachelor's Degree Required.

Work experience:

• A min of 5 yrs supervisory experience in a relevant capacity.

Specialized knowledge/skills:

• Healthcare knowledge, service operations, Managerial skills, Health Insurance, Supervisory Development/MDP program.

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.