Claims Quality Audit Director jobs in Inglewood, CA

Claims Quality Audit Director directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Provides professional knowledge and guidance on technical or procedural problems. Being a Claims Quality Audit Director creates claims audit policies and procedures. May recommend changes in claims processing procedures. Additionally, Claims Quality Audit Director typically Requires a bachelor's degree. Typically reports to top management. The Claims Quality Audit Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Quality Audit Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)

Q
Claims Appeal Auditor
  • QUALITY CARE SURGERY CENTER, LLC
  • Northridge, CA FULL_TIME
  • Essential Duties and Responsibilities include the following:
     
    1.Maintain the workflow of all departmental projects.
     
    2.Ensure priority sorting, batching & logging by provider and provider type for all correspondence
     
    3.Provide reports and on-going updates to Claims management.
     
    4.Assist in the processing of appeals (reconsiderations), special projects and reconciliations from all sources.
     
    5.Oversees staff activities to maintain high level of productivity.
     
    6.Monitor appeals related functions to ensure health plan and regulatory compliance.
     
    7.Participate with training determined by Unit Senior Manager and Auditing Staff regarding Claims Adjudication education issues discovered in reconsideration reviews.
     
    8.Provide primary support to the Senior Manager of Appeals including special projects.
     
    9.Recommend process improvements based on appeal tracking and trending reports.
     
    10.Support Senior Manager in other company functions such as Medical Review management Health Plan audits.
     
    11.Handle and document resolution to escalated telephone and written appeals.
     
    12.Implement and coordinate issue resolution processes.
     
    13.Liaison for department with outside providers and internal departments.
     
    14.Provide supervisory coverage for Appeals unit as needed.
     
    15.Other duties as directed by management.
     

    The pay range for this position at commencement of employment is expected to be between $22.50-24.50/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

     

    The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

     

    Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

     

    If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

     

     

    As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

     

    Full Time Position Benefits:

    The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

    Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

     

    Health and Wellness:

    • Employer-paid comprehensive medical, pharmacy, and dental for employees
    • Vision insurance
    • Zero co-payments for employed physician office visits
    • Flexible Spending Account (FSA)
    • Employer-Paid Life Insurance
    • Employee Assistance Program (EAP)
    • Behavioral Health Services

    Savings and Retirement:

    • 401k Retirement Savings Plan
    • Income Protection Insurance

    Other Benefits:

    • Vacation Time
    • Company celebrations
    • Employee Assistance Program
    • Employee Referral Bonus
    • Tuition Reimbursement
    • License Renewal CEU Cost Reimbursement Program
    • Business-casual working environment
    • Sick days
    • Paid holidays
    • Mileage

     

    Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

     

     

  • 1 Month Ago

U
Claims Quality Auditor
  • UCLA Health Careers
  • Los Angeles, CA FULL_TIME
  • DescriptionTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the ne...
  • 10 Days Ago

U
Claims Quality Auditor
  • University of California - Los Angeles Health
  • Los Angeles, CA FULL_TIME
  • DescriptionTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the ne...
  • 1 Month Ago

I
Managing Director - Internal Audit
  • Impact Solutions Inc
  • Sherman Oaks, CA FULL_TIME
  • We are a technical advisory services firm that works with the top local talent on the most comprehensive and intriguing projects for discerning clients ranging from start-ups to closely held mid-marke...
  • 11 Days Ago

I
Managing Director - IT Audit
  • Impact Solutions Inc
  • Sherman Oaks, CA FULL_TIME
  • We are a technical advisory services firm that works with the top local talent on the most comprehensive and intriguing projects for discerning clients ranging from start-ups to closely held mid-marke...
  • 11 Days Ago

I
Managing Director - Internal Audit
  • Impact Solutions Inc
  • North Hollywood, CA FULL_TIME
  • We are a technical advisory services firm that works with the top local talent on the most comprehensive and intriguing projects for discerning clients ranging from start-ups to closely held mid-marke...
  • 2 Days Ago

Filters

Clear All

Filter Jobs By Location
  • Filter Jobs by companies
  • More

0 Claims Quality Audit Director jobs found in Inglewood, CA area

N
Director, Clinical Quality Assurance & Compliance
  • Neogene Therapeutics
  • Santa Monica, CA
  • Pushing the frontier of solid cancer therapy, Neogene Therapeutics is a global, clinical stage biotechnology company bui...
  • 4/19/2024 12:00:00 AM

K
Director of Quality Control
  • Kalon Executive Search for Health and Wellness
  • Los Angeles, CA
  • Our client, a health and wellness company are seeking a qualified Director of Quality Control to help build a solid, sta...
  • 4/17/2024 12:00:00 AM

E
Director of Quality Assurance
  • Executive Alliance
  • Cypress, CA
  • Brief Description: Our client is seeking a talented and driven Director of Quality Assurance to join our team. In this r...
  • 4/17/2024 12:00:00 AM

H
Sr. Director of Quality Assurance
  • Hiring Now!
  • Diamond Bar, CA
  • At Niagara, we re looking for Team Members who want to be part of achieving our mission to provide our customers the hig...
  • 4/17/2024 12:00:00 AM

E
Director Of Quality Assurance
  • Executive Alliance
  • Cypress, CA
  • Job Description Job Description Our client is seeking a talented and driven Director of Quality Assurance to join our te...
  • 4/16/2024 12:00:00 AM

K
Director of Quality Control
  • Kalon Executive Search For Health And Wellness
  • Los Angeles, CA
  • Our client, a health and wellness company are seeking a qualified Director of Quality Control to help build a solid, sta...
  • 4/16/2024 12:00:00 AM

E
Director of Quality Assurance
  • Executive Alliance
  • Cypress, CA
  • Our client seeks a talented and driven Director of Quality Assurance to join our team. In this role, you will be respons...
  • 4/16/2024 12:00:00 AM

A
Division Director of Quality, Specialty Services
  • Acadia Healthcare - Orange County
  • Buena Park, CA
  • Overview: PURPOSE STATEMENT: The Division Director of Quality is a new and expanded role at Acadia Healthcare that is re...
  • 4/15/2024 12:00:00 AM

Inglewood is a city in southwestern Los Angeles County, California in the Los Angeles metropolitan area. As of the 2010 U.S. Census, the city had a population of 109,673. It was incorporated on February 14, 1908. The city is in the South Bay region of Los Angeles County. Los Angeles Stadium at Hollywood Park is currently under construction in the city and, when completed around 2020, will be the new home of both the National Football League's Los Angeles Rams and Los Angeles Chargers. The city is also close to Los Angeles International Airport....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Director jobs
$168,889 to $241,365
Inglewood, California area prices
were up 3.2% from a year ago

Claims Quality Audit Director in Olympia, WA
Based on our compensation data, the estimated salary potential for Claims Quality Audit Director will increase 16 % over 5 years.
December 23, 2019