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Alternate job titles: Claims Quality and Compliance 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. Creates claims audit policies and procedures. May recommend changes in claims processing procedures. Typically requires a bachelor's degree. Typically reports to top management. 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 f more...



Alternate job titles: Claims Quality and Compliance 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. Provides assistance in developing claims audit policies and procedures. May provide coaching in complex claims audit. Typically requires a bachelor's degree. Typically reports to a director or head of a department. 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 fo more...


Alternate job titles: Claims Quality Audit Director

The Claims Quality and Compliance Audit Director provides professional knowledge and guidance on technical or procedural problems. Directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Being a Claims Quality and Compliance Audit Director may recommend changes in claims processing procedures. Creates claims audit policies and procedures. In addition, Claims Quality and Compliance Audit Director typically requires a bachelor's degree. Typically reports to top management. The Claims Quality and Compliance Audit Director more...


Alternate job titles: Claims Quality and Compliance Audit Supervisor

Supervises and coordinates daily activities of claims quality auditors. Provides assistance in developing claims audit policies and procedures. Solves day-to-day problems and monitors the results of daily staff activities, reports critical issues and problems to the management. Typically requires a bachelor's degree. Typically reports to a manager. Supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Makes day-to-day decisions within or for a group/small department. Has some authority more...



Alternate job titles: Claims Quality Audit Supervisor

The Claims Quality and Compliance Audit Supervisor provides assistance in developing claims audit policies and procedures. Supervises and coordinates daily activities of claims quality auditors. Being a Claims Quality and Compliance Audit Supervisor typically requires a bachelor's degree. Solves day-to-day problems and monitors the results of daily staff activities, reports critical issues and problems to the management. In addition, Claims Quality and Compliance Audit Supervisor typically reports to a manager. The Claims Quality and Compliance Audit Supervisor supervises a group of primarily more...


Alternate job titles: Claims Quality Audit Manager

The Claims Quality and Compliance Audit Manager reviews and tracks claims quality audit reports and measures performance of auditors. Manages the claims quality auditors and daily activities of quality claims audit function. Being a Claims Quality and Compliance Audit Manager may provide coaching in complex claims audit. Provides assistance in developing claims audit policies and procedures. In addition, Claims Quality and Compliance Audit Manager typically requires a bachelor's degree. Typically reports to top management. The Claims Quality and Compliance Audit Manager manages subordinate sta more...



Alternate job titles: Claims Service and Operations Director

Directs and oversees the operations of an insurance claims department to meet operation, financial, and service requirements. Provides guidance and sets policies on insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Responsible for the strategic processing and payment of claims. Keeps abreast of any changes to legislation and regulations which pertain to insurance claims. Provides guidance to subordinates on the most complex claims. Requires a bachelor's degree. Typically reports to top management. Manages a departmental sub-function more...


Alternate job titles: Audit and Financial/Business Controls Director | Audit/Compliance Director | Internal Auditing Director

The Audit Director designs, develops, and implements internal auditing policies and procedures consistent with the organization's standards. Directs the auditing of accounting and financial data of various departments within an organization. Being an Audit Director identifies improper accounting or documentation and makes recommendations for improvement to top management. Ensures accuracy and compliance with government guidelines and laws. In addition, Audit Director requires a bachelor's degree of accounting or finance or its equivalent. Typically reports to a CFO or top management. The Audit more...


Alternate job titles: Audit and Financial/Business Controls Director | Audit Director | Internal Auditing Director

The Audit/Compliance Director designs, develops, and implements internal auditing policies and procedures consistent with the organization's standards. Directs the auditing of accounting and financial data of various departments within an organization. Being an Audit/Compliance Director identifies improper accounting or documentation and makes recommendations for improvement to top management. Ensures accuracy and compliance with government guidelines and laws. In addition, Audit/Compliance Director requires a bachelor's degree of accounting or finance or its equivalent. Typically reports to a more...



Alternate job titles: Claims Quality and Compliance Auditor I | Claims Quality Auditor - Associate

Audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Typically reports to a supervisor or a manager. Gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. Typically requires 2 to 4 years of related experience. more...


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