Claims Quality Audit Director jobs in Bradenton, FL

We help the world see new possibilities and inspire change for better tomorrows. Our analytic solutions bridge content, data, and analytics to help business, people, and society become stronger, more resilient, and sustainable.

We are seeking a Lead Claims Analyst for our Allocation Solutions Department. In this role you will be responsible for file intake and set up of all Medicare Secondary Payer (MSP) products, full review, analysis and response to submission requests and development letters, information and documentation follow-up, and client communication. Additionally, the Lead Claims Analyst will be responsible for team management, training of new employees, quality assurance reviews, daily team queue maintenance, and daily team production reports to management. The Lead Claims Analyst role is considered a “Subject Matter Expert” role and is heavily client facing. Each claims analyst is responsible for successful communication, timely responses and providing overall excellent customer service.

If you thrive in a fast-paced environment that emphasizes individual accountability with the support of a team structure, come join us!

About the Day to Day Responsibilities of the Role

• Manage a team of claims analysts and train new employees and current staff as needed
• Maintain/monitor daily production work queues
• Report team production and production blockers to department management
• Serve as Subject Matter Expert for peers, employees and current staff
• Intake incoming referrals into claims system, including initial follow-up for incomplete referrals for missing information
• Comprehensive review, analysis and response to CMS submission requests, development letters and all other communication received from CMS and/or their contractors
• Serve as primary point of contact for assigned clients
• Manage work queues for assigned clients and ensure adherence to client and internal SLA’s
• Communicate effectively, timely and comprehensively. Communication includes, but is not limited to, internal emails, client inquiries, case status requests, case updates and general subject matter questions
• Assist attorneys and staff as needed

About You and How You Can Excel in This Role

• Demonstrated subject matter expertise
• Detail oriented, organized, and quality focused
• Advanced customer service and communication skills, both verbal and written
• Excellent technical skills and working knowledge of Microsoft Office
• Able to work independently, self-directed, highly motivated
• Desire to work in a fast-paced, professional environment
• Flexible and adaptable
• 2-3 years’ experience
• Associate’s or bachelor’s degree preferred

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For over 50 years, Verisk has been the leading data analytics and technology partner to the global insurance industry by delivering value to our clients through expertise and scale. We empower communities and businesses to make better decisions on risk, faster.

At Verisk, you'll have the chance to use your voice and build a rewarding career that's as unique as you are, with work flexibility and the support, coaching, and training you need to succeed.

For the eighth consecutive year, Verisk is proudly recognized as a Great Place to Work® for outstanding workplace culture in the US, fourth consecutive year in the UK, Spain, and India, and second consecutive year in Poland. We value learning, caring and results and make inclusivity and diversity a top priority. In addition to our Great Place to Work® Certification, we’ve been recognized by The Wall Street Journal as one of the Best-Managed Companies and by Forbes as a World’s Best Employer and Best Employer for Women, testaments to the value we place on workplace culture.

We’re 7,000 people strong. We relentlessly and ethically pursue innovation. And we are looking for people like you to help us translate big data into big ideas. Join us and create an exceptional experience for yourself and a better tomorrow for future generations.

Verisk Businesses

Underwriting Solutions — provides underwriting and rating solutions for auto and property, general liability, and excess and surplus to assess and price risk with speed and precision

Claims Solutions — supports end-to-end claims handling with analytic and automation tools that streamline workflow, improve claims management, and support better customer experiences

Property Estimating Solutions — offers property estimation software and tools for professionals in estimating all phases of building and repair to make day-to-day workflows the most efficient

Extreme Event Solutions — provides risk modeling solutions to help individuals, businesses, and society become more resilient to extreme events.

Specialty Business Solutions — provides an integrated suite of software for full end-to-end management of insurance and reinsurance business, helping companies manage their businesses through efficiency, flexibility, and data governance

Marketing Solutions — delivers data and insights to improve the reach, timing, relevance, and compliance of every consumer engagement

Life Insurance Solutions – offers end-to-end, data insight-driven core capabilities for carriers, distribution, and direct customers across the entire policy lifecycle of life and annuities for both individual and group.

Verisk Maplecroft — provides intelligence on sustainability, resilience, and ESG, helping people, business, and societies become stronger

Verisk Analytics is an equal opportunity employer.

All members of the Verisk Analytics family of companies are equal opportunity employers. We consider all qualified applicants for employment without regard to race, religion, color, national origin, citizenship, sex, gender identity and/or expression, sexual orientation, veteran's status, age or disability.

http://www.verisk.com/careers.html

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