Supervisor Claims Quality Auditor

Supervisor Claims QA Responsible for overseeing the daily operation of the Claims Quality Team, managing the Claims’ Quality Review program, adhering to processing standards, responding to quality issues, partnering with operational areas to implement performance improvement plans, and ensuring timely and complete reporting to department leaders. Responsibilities Directly supervise the Claims Quality Assurance Team, mentoring and coaching team members to meet performance standards. Implement performance improvement plans and guide team members through corrective action as needed. Oversee audits of claims, verifying accuracy and compliance with standard processes and client plans. Monitor audit inventory against SLAs and reporting requirements. Compile and distribute audit reporting, documenting procedural and monetary errors for quality reporting and trending analysis using quality tools. Identify trends from quality reviews, propose improvement opportunities, and collaborate with the training team to develop training programs. Partner with Claims Department Leadership and Training Lead on urgent corrective actions. Qualifications Excellent verbal and written communication skills, with the ability to convey complex information clearly. Strong organizational, analytical, and problem‑solving skills with a high level of attention to detail. Ability to produce grammatically accurate, error‑free business correspondence. Experience leading and delegating tasks to multiple direct reports. Skill in identifying urgent situations and following appropriate protocols. Ability to plan and manage multiple priorities, delivering accurate results in a fast‑paced environment. Capacity to work under limited supervision and provide guidance and coaching to others. Excellent coaching skills with a focus on mentoring others toward quality improvement. Proficiency in MS Office applications. Education and Experience High School diploma or GED required; associate or bachelor’s degree preferred. Minimum five years of experience as a claims processor or quality assurance professional in a healthcare company, meeting production and quality goals. Detailed knowledge of processing principles, techniques, and guidelines. Strong knowledge of benefit plans, policies, procedures, and medical terminology. Experience with a highly automated and integrated claims adjudication system; El Dorado‑Javelina or Health Rules Payer experience preferred. Prior supervisory or lead experience with direct reports preferred. Ability to acquire and execute increasingly complex tasks in a production environment. Work Location Candidates located within commuting distance of the Buffalo office will be considered for in‑person or hybrid roles; all other applicants will be considered for remote positions. #J-18808-Ljbffr