Senior Manager - Claims Quality Assurance

5 days ago

Apply Now

Receive Emails with Similar Jobs

XO Health Inc.

WebsiteLinkedInAll Job Openings

11 - 50

Description

• XO Health believes healthcare is fixable. Become part of the community changing the face of the industry. • XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone. • We are growing a multi-disciplinary team of diverse and digitally empowered employees ready to rebuild trust in healthcare through comprehensive and unified transformation. • The Sr. Manager of Claims Quality Assurance will implement, develop, and lead a successful Claims Quality Assurance and Compliance team for XO Health Claims Operations. The successful candidate will promote a continuous improvement culture, enhance the quality of claims handling, define the framework, benchmarking and identify areas for improvement across the portfolio of XO Health Claims. • The successful candidate is a results-driven team player focused on continuous improvement and will support claims quality assurance and compliance objectives and strategies in partnership with XO Claims Operations Leadership and related internal stakeholders.

Requirements

• 7-10 years of experience with Quality Assurance and Compliance in CMS and commercial claims, reinsurance organizations with a complex operating environment. Experience working in the TPA (Third Party Administrator) organizations preferred. • In-depth experience reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB04, Universal Claims, Stop Loss, Surgery, Anesthesia, DME, Behavioral Health, high dollar complicated claims, COB, Subrogation, and DRG pricing). • In-depth knowledge of CMS, State, and ERISA laws and regulations related to healthcare claims processing. • Ability to accomplish tasks in a dynamic environment with an aptitude for analyzing data and making practical and forward-looking decisions to drive success. • Excellent communication skills and demonstrated ability and experience supporting strategic initiatives impacting key stakeholders and reporting to senior leadership. • Experience working on cross functional teams, collaborating, actively participating, and delivering solutions. • Strong organizational, critical thinking, problem solving, analytical, and quantitative skills including the ability to analyze and interpret financial and claims data. • The ability to issue spot and escalate issues that could present challenges to a project or the organization. • Strong conflict resolution skills to effectively deal with people with differing expectations and viewpoints. • Strong knowledge of skills in use of various software and insurance platforms and systems, i.e. claims auditing platforms and claims systems. • Excellent written and verbal communication skills.