Director, Claims Quality Assurance
Current• Provides oversight and management of member eligibility and enrollment activities.• Developed a claims quality assurance program inclusive of desk level procedures, enhanced claims auditing processes and internal quality audit procedures.• Manages planning, developing, and directing quality assurance policies, programs, and initiatives.• Leads audit plan strategies, implementation, and audit readiness activities.• Communicates with senior leaders and executives on quality initiatives and guidance for change management.• Identifies and assists in the resolution of operational issues using well defined/documented processes, expertise, and judgment.• Monitors system defects identified via audits. Provides feedback and corrective action on claims quality.• Monitors departmental processing activities to ensure quality, productivity, service level agreements and goals are achieved.
