Claims Quality Audit Manager jobs in New Jersey

Claims Quality Audit Manager manages the claims quality auditors and daily activities of quality claims audit function. Reviews and tracks claims quality audit reports and measures performance of auditors. Being a Claims Quality Audit Manager provides assistance in developing claims audit policies and procedures. May provide coaching in complex claims audit. Additionally, Claims Quality Audit Manager typically requires a bachelor's degree. Typically reports to a director or head of a department. The Claims Quality Audit Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Claims Quality Audit Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)

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Health Claims Audit Manager
  • WithumSmith+Brown
  • Princeton, NJ FULL_TIME
  • Looking to work at a firm with an unbeatable culture? 

    Withum is a forward-thinking, technology-driven advisory and accounting firm, helping clients to Be in a Position of StrengthSM in today’s modern business landscape. Withum empowers clients with innovative tools and solutions to address their accounting, tax and overall business management needs. Withum is a place where talent thrives. We recruit only the best and brightest people, with a genuine passion for the business. 

    Withum is seeking an experienced health claims auditor possessing in-depth knowledge of group health and disability claims procedures, medical/dental terminology, including CPT, ADA, HCPC and ICDA codes, and a thorough understanding of automated health claims systems as well as manual claims payment systems.

    How You’ll Spend Your Time:

    • Working closely with our clients to ensure that health, dental, prescription and vision claims are being paid in compliance with regulations and plan documents
    • Reviewing client's claims adjudication internal controls policies and procedures
    • Completing audit workpapers documenting procedures, findings and conclusions within assigned budgets and deadlines
    • Responsible for scheduling and oversight of claims team (3-5 at any given time)
    • Review work of team members and present to engagement partner for their final review

    The Type's of People We Look For Have the Following Qualities:

    • BS Degree
    • Must be qualified at analyzing and interpreting group health insurance contract provisions and reviewing administrative policies and PPO contracts
    • Experience supervising staff and working within a team environment
    • Must be familiar with HIPAA and ACA compliance standards
    • Must have a minimum of 7-10 years of health claims processing experience (internal auditing skills a plus)
    • Good computer skills (Microsoft office preferred), excellent communication skills
    • Ability to travel
    • 2-4 years of managerial experience in health claims processing is a plus

     

    The compensation for this position will vary by location. If you reside in San Ramon, CA please see below. In addition to the base compensation, Withum offers a competitive benefits package and bonus program (for eligible roles) based on individual and firm performance. Final offer amounts are based on multiple factors such as the specific role, hiring location, as well as the individual’s skills, experience and qualifications. For additional information on our benefits, visit our website at https://www.withum.com/careers/.

    California ranges are from $90,000-$120,000 annually
    New York ranges are from $90,000-$120,000 annually
    Washington DC ranges are from $90,000-$120,000 annually

    Withum will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or because he or she is a protected veteran. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Remotely anywhere within the United States except the States of Colorado & New York.

    #LI-MM1

     

  • Just Posted

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Audit Manager – Quality Control
  • Global Placement Firm
  • Livingston, NJ FULL_TIME
  • Excellent Company Looking To Add An Audit Manager - Quality Control To Their Team! General Summary Our Team is a specialized group in our Assurance practice. Primary responsibilities of the group incl...
  • 19 Days Ago

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Manager, Quality Audit & Coaching
  • Horizon Blue Cross Blue Shield of New Jersey
  • Newark, NJ FULL_TIME
  • Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:Responsible for the creation and execution of quality audit and coaching plans for new hire...
  • 25 Days Ago

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Quality Assurance Audit Manager
  • Mercadien Consulting LLC
  • Hamilton, NJ FULL_TIME
  • DescriptionAre you looking for an opportunity to work for a professional firm that offers flexibility? If so, seize this opportunity! The Mercadien Group is looking for a Quality Assurance Audit Manag...
  • 3 Days Ago

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Audit Manager - Quality Assurance
  • Mercadien Consulting LLC
  • Hamilton, NJ FULL_TIME
  • DescriptionAre you looking for an opportunity to work for a professional firm that offers flexibility? If so, seize this opportunity! The Mercadien Group is looking for an Audit Manager to become part...
  • 1 Month Ago

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Quality Assurance Manager (Audit)
  • BAP Pharma Ltd
  • Somerset, NJ FULL_TIME
  • JOB TITLE – QUALITY ASSURANCE MANAGER – AUDIT (6 MONTH CONTRACT) The role of the Quality Assurance Manager (Audit) is to support the Senior Manager in ensuring that that BAP US Inc. is compliant with ...
  • 1 Month Ago

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Production Manager
  • Archetype Permanent Solutions
  • Houston, TX
  • We are seeking an experienced Production Manager to oversee our production operations. The ideal candidate will be a hig...
  • 3/28/2024 12:00:00 AM

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Quality Control Inspector
  • GE
  • Charleroi, PA
  • Job Description Summary This role will be responsible for Quality support to production. This includes in-process inspec...
  • 3/27/2024 12:00:00 AM

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Product Quality Manager (Quality Engineer III)
  • Russell Tobin
  • Cupertino, CA
  • Job Description Job Description Job Title: Product Quality Engineer Duration: 6+ Months with possible extensions Locatio...
  • 3/27/2024 12:00:00 AM

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Quality Supervisor
  • Doherty Staffing Solutions
  • Le Sueur, MN
  • Job Description Job Description Looking to apply your quality experience in the food industry? Doherty Staffing Solution...
  • 3/27/2024 12:00:00 AM

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Production Manager
  • Archetype Permanent Solutions
  • San Antonio, TX
  • We are seeking an experienced Production Manager to oversee our production operations. The ideal candidate will be a hig...
  • 3/25/2024 12:00:00 AM

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Quality Assurance Supervisor
  • Eurofins
  • Columbia, MO
  • Company Description Eurofins Scientific is an international life sciences company, providing a unique range of analytica...
  • 3/25/2024 12:00:00 AM

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Production Manager
  • Archetype Permanent Solutions
  • Fort Worth, TX
  • We are seeking an experienced Production Manager to oversee our production operations. The ideal candidate will be a hig...
  • 3/25/2024 12:00:00 AM

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Quality Assurance Manager, Behring Korea
  • CSL Behring
  • Seoul, Seoul
  • Position Purpose: The purpose of the Quality Assurance Manager role is to operate a local Quality system in the territor...
  • 2/27/2024 12:00:00 AM

New Jersey is bordered on the north and northeast by New York (parts of which are across the Hudson River, Upper New York Bay, the Kill Van Kull, Newark Bay, and the Arthur Kill); on the east by the Atlantic Ocean; on the southwest by Delaware across Delaware Bay; and on the west by Pennsylvania across the Delaware River. New Jersey is often broadly divided into three geographic regions: North Jersey, Central Jersey, and South Jersey. Some New Jersey residents do not consider Central Jersey a region in its own right, but others believe it is a separate geographic and cultural area from the Nor...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Manager jobs
$106,135 to $142,589

Claims Quality Audit Manager in Kennewick, WA
Based on our compensation data, the estimated salary potential for Claims Quality Audit Manager will increase 16 % over 5 years.
January 17, 2020
Claims Quality Audit Manager in Canton, OH
On average, a Bachelor's Degree is the highest level of education for a Claims Quality Audit Manager.
January 04, 2020