Supervisor, Claims Quality Auditor

🕒 April 25

🇺🇸 United States – Remote

💵 $65k - $70k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Centivo

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2017

⚕️ Healthcare Insurance

Healthcare Insurance

Centivo is an innovative health plan provider for self-funded employers that focuses on delivering high-quality healthcare at an affordable cost. The company believes in the power of primary care to improve health outcomes and reduce costs. Centivo offers plans with free primary care, no deductibles, and low, predictable copays, thereby encouraging members to utilize their health benefits without financial burden. The plans are curated to meet stringent price and quality standards, promoting a strong relationship with primary care providers and integrating virtual care options. Centivo's approach is designed to reduce overall medical expenses while enhancing the healthcare experience for both employers and employees.

📋 Description

• Oversight and management of the Claims Quality Assurance Team, including mentoring the team, implementing and coaching through performance improvement plans, and training auditors on job performance expectations. • Reviewing audits of claims, ensuring processing accuracy by verifying all aspects of the audit have been handled correctly and according to both standard processes and the Client’s summary plan description. • Managing the inventory of audits against standard service level agreements (SLA’s) and reporting requirements. • Compiling reporting of audits completed, with decision methodology for procedural and monetary errors which are used for quality reporting and trending analysis utilizing quality tools. • Identifying trends based on the quality reviews, identifies quality improvement opportunities and partners with training team to develop programs. • Partnering with Claims Department Leadership and Training Lead on any problematic issues warranting immediate corrective action.

🎯 Requirements

• High School diploma or GED required, Associate or Bachelor’s degree preferred. • Minimum of three (3) years of experience in a claim examiner or quality assurance role with a health care company, meeting production and quality goals/ standards. • Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines. • Ability to acquire and perform progressively more complex skills and tasks in a production environment. • Proficient experience in MS Word, Excel, Outlook, and PowerPoint. • Experience with a highly automated and integrated claim adjudication system.

🏖️ Benefits

• Offers Equity • Offers Bonus