Claims Quality Audit Manager jobs in Somerset, NJ

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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AVP, Global Claims Quality Assurance
  • Everest National Insurance Company
  • Warren, NJ FULL_TIME
  • Title: AVP, Global Claims Quality Assurance Company: Everest Insurance Company Job Category: Claims Job Description: An exciting opportunity to join one of the fastest growing insurance companies in a truly global role where you can make a difference and have real influence! Whilst Everest has a 40-year history of success, Everest Insurance is still relatively young and is experiencing significant continued growth resulting in exciting and challenging opportunities. Everest has been a global leader in reinsurance with a broad footprint, deep client relationships, underwriting excellence, responsive service, and customized solutions. Our insurance arm draws upon impressive global resources and financial strength to tailor each policy to meet the individual needs of our customers. Throughout our history, we have maintained our discipline and focus on creating long term value through underwriting excellence and strong Risk and Capital Management. We believe that our future is determined by the actions we take today, actions that go beyond business strategy and encompass the values important both to us and the communities in which we operate. Role Purpose: As a member of the Global Claims Quality Assurance program within Everest Insurance, the purpose of this role is to perform technical and operational claim audits, data analysis, training, reporting, audit system support, and other activities that will improve claim outcomes, avoidance of loss cost leakage, mitigate risk, and demonstrate quantifiable improvement. Travel: 10-20%. May require two-week domestic or international travel over weekends. Key Accountabilities: What do we expect you to do? On a Strategic Level Design support for and validation of QA function controls, process, capabilities, performance tracking Leadership of Quality Review and Focus Reviews. May be asked to perform reviews Re-Review of Supervisory Reviews to ensure supervisors are accurately reviewing files Performance MI & recommendations to continually enhance and improve QA Best Practice Subject Matter Expertise TeamThink QA System Development UAT, and Support Perform Operational Risk and Controls Reviews Delivery of Audit Findings Improvement Plan monitoring Operational expectations Audit Leader for Claim Best Practice-Leakage, and Controls based (operational) Audits. May be asked to participate on reviews as an auditor, and or conduct Supervisory Reviews Ensure accuracy of all audit findings, information, and documents Dissect complex data sets, identifying “root cause” of issues/trends related to non-compliance. Develop audit plans and scope by reviewing available information and conducting research and analysis Plan audits and write clear and concise reports that give senior executives key information. Reports must be balanced, constructive and help management grasp the key issues in a way that will encourage them to be proactive Develop and monitor measurable improvement plans and effectively communicate so that management, QA team, and stakeholders are all working together Comply with all applicable standards, policies, guidelines, and procedures. Ensure BPs and standards are effectively designed, in place, and operating as intended Support of business cases for the implementation of technology solutions Anticipated overnight travel is 10% but could reach 20%. Will likely be in peaks and may include international travel 2 weeks at a time Must be fluent in English, with fluency in second language preferred Flexibility to work within global time zones, including travel, meetings while working remotely, etc. Execution of yearly business goals Timely and high-quality delivery of Audits People expectations Highly collaborative and communicative stakeholder engagement with Regional Claim teams and stakeholders Deliver audit objectives by leading teams who are not direct reports. This may include Everest guest auditors, colleagues, or external vendors Evaluation of staff training needs and coaching Align, empower, and influence others through ideas, encouragement, and insight In future, position may require managing direct reports What skills do we expect you to have? Skills & Abilities: 10 or more years of commercial technical claim adjusting experience with specialization in at least one Technical Line Experienced in leading and managing claims technical quality audits Deep knowledge of Claims processes and organizations; will preferably have a background in claim management Ability to learn and apply claim best practice standards to claim files. Ability to learn and navigate Everest and TPA claim systems effectively Strategic thinker, innovative and solution-oriented Exceptional oral and written communication, with the ability to provide concise executive summaries and audit reports to senior management Highly collaborative and able to work effectively across the organization as well as with external stakeholders Ability to adapt and embrace change, solutions driven Ability to perform root cause analysis of complex claim handling and controls issues to identify appropriate improvement solutions Ability to analyze training needs and situations to determine if performance can be improved through training Ability to work independently on assignments of moderate to high complexity Courage to face difficult issues, and to provide direct and actionable feedback despite dissent or political risk Strong interpersonal skills and demonstrates respect for the opinions of others Professional qualifications and experience: Experience in technical insurance claims auditing required, preferably as a QA Manager Demonstrable extensive experience in Claims Quality Assurance in a P&C insurance environment. International experience is preferred A degree educated professional, preferred Demonstrative experience with software applications, including multiple claim systems, QA web-based auditing tool, Microsoft Office, with heavy focus on MS Excel spreadsheets, charts, and pivot tables Competencies: As a leader within Claims must champion the Everest Insurance Culture: Collaboration: Open and transparent communication with customers and colleagues Diversity, Equity, and Inclusion: Through a welcoming and open environment that values all individuals Thoughtful Assumption of Risk: Supporting the Everest goal of carefully writing profitable business by ensuring data quality, prompt and accurate feedback to Underwriters, and operational control throughout the enterprise Execution: Delivering outstanding support to the organization through strong day-to-day business operations, effective project management, and careful oversight of vendors Humility: Caring and respectful approach to service colleagues, customers, and the community Leadership: By example, every day The Everest Core Values are the foundation upon which we (a) conduct our work, and (b) conduct ourselves both internally with our colleagues, and externally with clients/customers. The Company's success and that of our employees begins with these values. All employees are expected to support and exhibit these values in their interactions with others and through their day-to-day responsibilities. Our Culture At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture. Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Diversity, Equity and Inclusion. Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together. All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve. #LI-Hybrid #LI-AS1 Type: Regular Time Type: Full time Primary Location: Warren, NJ Additional Locations: Philadelphia, PA, Stamford, CT Everest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at everestbenefits@everestglobal.com. Everest U.S. Privacy Notice | Everest (everestglobal.com) Beware of recruitment fraud Please be cautious of phishing scams involving fake Everest job postings and individuals posting as Everest representatives making phony job offers. Always verify the identity of the recruiting professionals you work with. What you should know: At Everest, your privacy, security, and safety are of utmost importance to us. Everest will never ask for payment or any financial information as part of the hiring process. All job-related written communications from our internal recruitment team will come from official email addresses that end in our company domain. EVEREST is a leading international reinsurance and insurance group with an extensive distribution network that spans five continents. With roots dating back to 1973, Everest has developed a global footprint and deep client relationships that are largely unmatched by its peers. The Company’s principal business strategies seek to leverage its strengths to optimize returns over the underwriting cycle, thereby creating value for its shareholders and business partners.
  • 1 Month Ago

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Maintenance Manager
  • Top Quality Recruitment (TQR)
  • Somerset, NJ FULL_TIME
  • Employment Type: Full-time Available Positions: 1 Location: On-Site Application Deadline: September 26th, 2024 Summary The Maintenance Reliability Manager will be responsible for providing leadership ...
  • 20 Days Ago

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General Manager
  • Oakland Manager LLC
  • Somerset, NJ FULL_TIME
  • What You’ll Do: Inspire your team to deliver exceptional customer experiences, driving sales and consistently surpassing key performance indicators (KPIs).Build a high-performing, diverse team by attr...
  • 17 Days Ago

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Dental Office Manager
  • GD NJ Manager LLC
  • Randolph, NJ FULL_TIME
  • Location:Smith Family DentistrySmith Family Dentistry, the leading dental practice serving Randolph, NJ, and the greater Morris County area, is seeking an experienced Dental Office Manager to join our...
  • 14 Days Ago

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Assistant General Manager
  • Oakland Manager LLC
  • Somerset, NJ FULL_TIME
  • What You’ll Do as an Assistant Store Manager: Support the Store Manager in inspiring your team to deliver exceptional customer experiences, driving sales, and consistently achieving key performance in...
  • 17 Days Ago

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Senior Manager Sales Tax Audit
  • Verizon
  • Basking Ridge, NJ FULL_TIME
  • When you join VerizonYou want more out of a career. A place to share your ideas freely — even if they’re daring or different. Where the true you can learn, grow, and thrive. At Verizon, we power and e...
  • 7 Days Ago

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0 Claims Quality Audit Manager jobs found in Somerset, NJ area

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Mechanical/Fabricator Assembly Technician
  • ELITE PERFORMANCE STAFFING LLC
  • Highland Park, NJ
  • Job Description Job Description Mechanical/Fabricator Assembly Technician Somerset, NJ Day Shift and Night Shift Summary...
  • 12/14/2024 12:00:00 AM

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QA Specialist III
  • Kashiv Biosciences LLC
  • Piscataway, NJ
  • Job Type Full-time Description Position Summary Specialist III QA is a regular employee in a full-time exempt position a...
  • 12/14/2024 12:00:00 AM

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Shift Leader
  • Taco Bell
  • New Brunswick, NJ
  • Live MAS ... & Grow your Career at TACO BELL 'TOP FRANCHISE' 3 Years Running - Entrepreneur '100 Most Influential Compan...
  • 12/13/2024 12:00:00 AM

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Production Manager, Gene Synthesis
  • Genscript Biotech Corp
  • Piscataway, NJ
  • About GenScript GenScript Biotech Corporation (Stock Code: 1548.HK) is a global biotechnology group. Founded in 2002, Ge...
  • 12/13/2024 12:00:00 AM

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Senior Manufacturing Engineer - New Product Introduction
  • Veeco Instruments, Inc.
  • Somerset, NJ
  • About Veeco You probably don't realize it, but what we do at Veeco touches the lives of every person, every day. It's a ...
  • 12/12/2024 12:00:00 AM

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Shift Leader
  • Taco Bell
  • Edison, NJ
  • Live MAS ... & Grow your Career at TACO BELL 'TOP FRANCHISE' 3 Years Running - Entrepreneur '100 Most Influential Compan...
  • 12/12/2024 12:00:00 AM

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QA Specialist
  • Astrix Technology
  • New Brunswick, NJ
  • QA Specialist Quality Assurance Middlesex County, NJ, US Pay Rate Low: 40.00 | Pay Rate High: 50.00 + Added - 18/10/2024...
  • 12/11/2024 12:00:00 AM

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QC Sr. Lab Tech
  • Sun Pharmaceutical Industries
  • New Brunswick, NJ
  • COME WORK FOR US - INVESTING IN YOU AS A SUN PHARMA EMPLOYEE! * Medical, Dental, Vision Benefits * Health Savings Accoun...
  • 12/10/2024 12:00:00 AM

Somerset is an unincorporated community and census-designated place (CDP) located within Franklin Township, in Somerset County, New Jersey, United States. As of the 2010 United States Census, the CDP's population was 22,083. Somerset housed one of the first Marconi Wireless Stations in the United States. According to the United States Census Bureau, the CDP had a total area of 6.444 square miles (16.692 km2), including 6.327 square miles (16.388 km2) of land and 0.117 square miles (0.304 km2) of water (1.82%)....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Manager jobs
$110,924 to $149,023
Somerset, New Jersey area prices
were up 1.5% from a year ago

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
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