Senior Manager, Quality Audit

🔥 16 hours ago

🇺🇸 United States – Remote

💵 $155k - $165k / year

⏰ Full Time

🟠 Senior

👔 Manager

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Plan, develop, organize, direct and evaluate all aspects of onshore and offshore BPaaS activities • Serve alongside multiple stakeholders, including Configuration, IT Operations, Contact Center Operations, and Medical Management to deliver customer success • Establish operational objectives, policies and procedures ensuring compliance with customer contracts and related laws and regulations • Develop and execute strategies to achieve key performance measures • Identify, recommend, and implement new processes, technologies, and systems to improve and streamline processes and use of resources • Establish and administer the department budget • Provide Executive level briefings to Senior Leadership at regular intervals to keep leadership current with updates and performance levels • Establish strong, collaborative relationships with client leadership

🎯 Requirements

• Bachelor’s Degree in Business, Health Services Administration, or related field • A minimum of 8 years of progressive management experience in health plan operations, with a strong understanding of claims processing • 5 – 7 years Medicare Advantage experience preferred

🏖️ Benefits

• Health insurance • Paid time off • Flexible work arrangements • Professional development