Claims Quality Audit Director jobs in Pensacola, FL

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)

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Workers' Compensation Claims Director
  • LandrumHR
  • Pensacola, FL OTHER
  • Workers' Compensation Claims Director
    LandrumHR in Pensacola is looking to bring in a hardworking and reliable Workers' Compensation Claims Director who oversees the various facets of workers’ compensation claims and medical case management as indicated in the performance of the following job duties. This is an excellent opportunity for someone who is looking for steady, full-time work with a company that looks after its employees.

    What you’ll be doing:
    • Manage and lead team, providing guidance, mentorship, and support to ensure delivery of objectives.
    • Conduct periodic performance evaluations and provide constructive feedback to team members, setting goals and expectations and ensuring alignment with overall organizational objectives.
    • Responsible for PEO & WFS clients/employees reporting new injuries and directing medical care if appropriate.
    • Determines compensability of claims and coordinates medical appointments/referrals for injured employees.
    • Manages Medical and Indemnity WC claims - by maintaining rapport through phone contact, meetings, and correspondence with injured employees, physicians, adjusters, rehabilitation providers, physical and occupational therapists, and employers when needed.
    • Assists employee/employer/physician with stay or return to work efforts including work-related restrictions.
    • Prepares online First Report of Injury for respective insurance company within 2 days from report to LandrumHR.
    • Completes Wage Loss Statements.
    • Updates / maintains accurate claim information in LandrumHR CRM database, which includes correspondence, medical treatment notes, future appointments and return to work status.
    • Ensures claimants are following up with requisite medical treatment/appointments.
    • Collaborates with TPA and Carrier adjusters to facilitate the best claim outcomes.
    • Manages complex litigated claims, attends mediations, and possibly final hearings, and depositions and testifies at hearings if necessary.
    • Conducts strategic settlement planning with assigned claims adjuster and defense attorneys.
    • Obtains and Reviews Injury / Incident & Investigation Report.
    • Responsible for reviewing monthly loss run reports (PMA & Liberty Mutual) for accuracy to ensure claim closure promptly.
    • Provides updates on select open claims at monthly meetings.
    • Review Post Job Offer Medical questionnaires to identify concerns about noted limitations and job description.
    • Communicates with CFO on all settlement offers and significant incurred claim changes.
    • Collaborates with the Director of Risk Management to target client strategies based on trends, claim investigations, and onsite safety inspections/training.
    What you’ll bring to the job:
    • Minimum of an associate degree and 5 years WC claims experience or related insurance / claims management experiences.
    • If no college degree must have a minimum of 7 years of experience in WC Claims management, and knowledge of, Florida’s Workers’ Compensation Law.
    • Knowledge of OSHA regulations particularly record keeping is preferable.
    • State Workers’ Compensation Adjuster license is required.
    • Must maintain required Workers’ Compensation Adjuster CEU’s.
    • Certifications such as Associate in Claims (AIC) or Certified Workers’ Compensation Professional are preferred.
    • Ability to manage and develop a high-performing team.
    • Availability to work beyond regular business hours when necessary.
    • Availability for potential travel commitments.
    What’s in it for you:
    • Potential to showcase what you can do and potentially earn a permanent position after working 600 hours with LandrumHR
    • After meeting the qualification requirements, employees are offered: Health Insurance, Dental Insurance, Vision Insurance, Matching 401k
    LandrumHR Workforce Solutions does not discriminate based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, marital status, pregnancy, genetic information or any other characteristic protected by law. It is our intention that all qualified applicants are given equal opportunity and that employment decisions be based on job-related factors.
  • 17 Days Ago

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Quality reviewer
  • 2M Quality
  • Santa Rosa, FL FULL_TIME
  • This is a part time, 1099 position. Job duties include : Looking at newly built homes from a customer's perspective to identify defects in workmanship, quality, completeness, consistency, and professi...
  • 2 Days Ago

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Field Roof Inspector - Panama City Beach, FL
  • Hancock Claims Consultants Technicians
  • Panama, FL CONTRACTOR
  • Hancock Claims Consultants specialize in Ladder Assist and Property Inspection Services, collaborating directly with numerous insurance agencies for efficient claims management.At Hancock, we are at t...
  • 12 Days Ago

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Field roof inspector
  • Hancock Claims Consultants Technicians
  • Panama, FL FULL_TIME
  • Hancock Claims Consultants specialize in Ladder Assist and Property Inspection Services, collaborating directly with numerous insurance agencies for efficient claims management. At Hancock, we are at ...
  • 12 Days Ago

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QUALITY DIRECTOR FILTRATION – MEMBRANE SITES
  • Danaher
  • Pensacola, FL FULL_TIME
  • Be part of something altogether life-changing!Working at Cytiva means being at the forefront of providing new solutions to transform human health. Our incredible customers undertake life-saving activi...
  • 2 Months Ago

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New Home Quality Reviewer
  • 2M Quality
  • Santa Rosa, FL PART_TIME
  • This is a part time, 1099 position. Job duties include: Looking at newly built homes from a customer's perspective to identify defects in workmanship, quality, completeness, consistency, and professio...
  • 2 Days Ago

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0 Claims Quality Audit Director jobs found in Pensacola, FL area

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Registered Nurse On Call
  • Gentiva Hospice
  • Pensacola, FL
  • Our Company: Gentiva Hospice is a member of the Gentiva family an industry leader in hospice, palliative, home health, a...
  • 5/10/2024 12:00:00 AM

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RN Clinical Manager, Home Health
  • CenterWell Home Health
  • Pensacola, FL
  • Become a part of our caring community and help us put health first The Clinical Manager coordinates and oversees all dir...
  • 5/10/2024 12:00:00 AM

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Shift Leader-Pensacola Pine Forest-4495
  • Ruby Tuesday
  • Pensacola, FL
  • Job Description This position is responsible for the day-to-day management of the restaurant. Responsible for teaching, ...
  • 5/8/2024 12:00:00 AM

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Manufacturing Engineer
  • Ascend Performance Materials
  • Pensacola, FL
  • POSITION OVERVIEW Ascend Performance Materials is the premium provider of high-quality chemicals, fibers and plastics. W...
  • 5/8/2024 12:00:00 AM

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Region Manager
  • Tom Thumb
  • Pensacola, FL
  • Description: Position Summary: If you are a highly motivated, dedicated and results driven person who is passionate abou...
  • 5/8/2024 12:00:00 AM

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Civil Senior Project Manager - Pensacola, FL
  • Bowman Consulting Group, Ltd.
  • Pensacola, FL
  • Short Description: Bowman has an opportunity for a Senior Project Manager, Civil to join our team in FL - Pensacola (FE)...
  • 5/8/2024 12:00:00 AM

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Patient Care Manager/Clinical Manager (RN)
  • LHC Group
  • Pensacola, FL
  • Job Description We are hiring a Patient Care Manager with Home Health experience! At Baptist Home Health Care, a part of...
  • 5/8/2024 12:00:00 AM

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Manufacturing Engineer II
  • Raytheon Technologies
  • Foley, AL
  • Date Posted: 2024-04-02 Country: United States of America Location: HAL02: Aerostructures-Foley 1300 West Fern Ave, Fole...
  • 5/6/2024 12:00:00 AM

Pensacola (/ˌpɛnsəˈkoʊlə/) is the westernmost city in the Florida Panhandle, approximately 13 miles (21 km) from the border with Alabama, and the county seat of Escambia County, in the U.S. state of Florida. As of the 2010 census, the city had a total population of 51,923, down from 56,255 at the 2000 census. Pensacola is the principal city of the Pensacola metropolitan area, which had an estimated 461,227 residents in 2012. Pensacola is a sea port on Pensacola Bay, which is protected by the barrier island of Santa Rosa and connects to the Gulf of Mexico. A large United States Naval Air Statio...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Director jobs
$137,725 to $196,821
Pensacola, Florida area prices
were up 1.5% 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