Claims Quality Audit Supervisor jobs in Buffalo, NY

Company :

Job Description : 

JOB SUMMARY

This job supervises and coordinates the day to day activities of the various claims processing or claims adjustment units responding to internal inquiries or inquiries received by members, providers, or account representatives across all markets.

ESSENTIAL RESPONSIBILITIES

• Communicate effectively.
• Effectively supervise all assigned personnel.
• Coordinate any claim backlog distribution for regular and overtime work both interdepartmentally and companywide. 
• Monitor and manage daily inventories to ensure adequate staffing and resources are available.
• Subject matter expert for benefit plan and claims processing issues, implementation of new groups and products, and transition meetings.
• Research quality issues and respond to error assessments.
• Ensure all business processes are routinely monitored.  Recommend and design, if necessary, process improvements designed to improve accuracy, timeliness of process and/or eliminate manual effort.
• Other duties as assigned or requested.

EDUCATION

Required

• High School Diploma or GED

Substitutions

• None

Preferred

• Bachelor’s degree

EXPERIENCE

Required

• 2 years experience in a claims environment
• 1 year experience leading or supervising others

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Knowledge of multiple processing systems and workflows

• Knowledge of claims processing methodologies

• Ability to interpret all government regulations.

• Knowledge of Highmark products.

Language (Other than English)

None

Travel Requirements

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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