Claims Quality Assurance Supervisor
Summary
Supervises a para-professional team auditing processed medical claims (pre- and post-pay) at WelbeHealth, a health plan serving vulnerable seniors, ensuring accurate, timely, compliant payments under Medicare/Medicaid rules. Drives data-driven audits, trend analysis, workflow improvement, and team coaching and development.
At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant focus lead the way no matter what.
The Claims Quality Assurance Supervisor is accountable for developing and overseeing a group of para-professional level team members to ensure accuracy, efficiency, and compliance with contractual and regulatory requirements of processed claims on a pre and post pay basis.
This role is different because the Claims Quality Assurance Supervisor WelbeHealth:
- Leads claims quality assurance strategy and execution, ensuring accurate and timely claims payments while maintaining compliance with Medicare, Medicaid, contractual, and regulatory requirements across a growing healthcare organization
- Drives continuous improvement through data-driven auditing, trend analysis, and cross-functional collaboration, while developing team members, strengthening workflows, and implementing quality standards that support operational excellence and accurate claims processing
We care about our team members. That’s why we offer:
- Medical insurance coverage (Medical, Dental, Vision)
- Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
- 401K savings + match
- Comprehensive compensation package including base pay and bonus
- And additional benefits!
On the day-to-day, you will:
- Oversee auditing activities, that claims are paid in an accurate and timely manner and in accordance with internal and external regulations and guidelines
- Identify issues and operational gaps, develop solutions, and make recommendations for improvement regarding processing and training
- Track progress and communicate audit results on a regular basis to impact parties
- Make recommendations related to identified trends or improvements, and work with management and team members in other departments to implement changes as directed by identified trends
- Create and update team procedures, workflows, and resource materials
- Monitor the results of daily team member activities, reporting critical issues and concerns to management, as well as serve as the primary point of escalation for issues related to quality assurance
- Evaluate team member performance and provide feedback, coaching, and counseling when performance issues arise, as well as identify training gaps and opportunities for improved performance
Job requirements include:
- Associate’s degree preferred; relevant professional experience in a health plan environment with an emphasis on billing, claims payment, coding or other closely related functions may be substituted
- Minimum of five (5) years of experience in health plans; managed care or PACE strongly preferred
- Experience in a claims processing environment with an emphasis on claims auditing
- Progressively responsible experience with demonstrated ability to mentor team members required
- Working knowledge in Medicare and Medicaid billing and guidelines, and the ability to understand and analyze contractual and regulatory requirements and their effect on claims payment and resolutions
- Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects
- Comprehensive knowledge of claims processing and regulations, strong problem solving skills, and the ability to analyze problems and formulate solutions
We’re seeking a strategic, detail-oriented Claims Quality Assurance Supervisor who is passionate about claims accuracy, regulatory compliance, and continuous improvement. If you’re ready to join a team that values both its participants and team members, we’d love to hear from you!
Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.
COVID-19 Vaccination Policy
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
Our Commitment to Diversity, Equity and Inclusion
At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Beware of Scams
Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com
Skills
As published by greenhouse · 16 questions · 3 written answers
Basics
First Name, Last Name, Preferred First Name, Email, Phone, Resume/CV, Cover Letter
Short answers (3)
- Please provide the URL to your LinkedIn profile for consideration as part of your application.
- What is your desired pay?
- If you were referred, please specify the referring individual's first and last name. Otherwise, enter “N/A."
Pick from a list (10)
- Do you have an associate degree or higher, or equivalent professional experience in a health plan environment focused on billing, claims payment, coding, or a closely related function?
- How many years of professional experience do you have working in a health plan environment, such as managed care or a Program of All-Inclusive Care for the Elderly (PACE) organization?
- How many years of experience do you have working in claims processing, with a specific emphasis on claims auditing or quality assurance?
- How many years of experience do you have directly supervising, mentoring, coaching, or developing team members in a professional setting?
- Which of the following best describes your experience with Medicare and/or Medicaid billing guidelines, claims processing, and regulatory requirements?
- Have you been referred by a current WelbeHealth employee?
- Are you a current employee of WelbeHealth?
- Texting Consent Policy
- Have you ever worked for WelbeHealth?
- Will you now or in the future require employer-sponsored work authorization or visa sponsorship to legally work in the United States? Applicants must be legally authorized to work in the United States without current or future employer sponsorship. At this time, WelbeHealth does not provide any employment-based visa sponsorship, including H-1B, TN, E-3, O-1, F-1 OPT/STEM OPT, or other employment-based work authorization.
Written answers (3)
- Describe your experience interpreting and applying contractual, regulatory, Medicare, or Medicaid requirements to claims payment, auditing, and resolution.
- Describe your experience conducting claims audits, identifying trends or processing errors, and implementing corrective actions or process improvements. Please include an example of an improvement you helped implement and its impact, if applicable.
- Do any of your relatives currently work for or at WelbeHealth? If so, who?