Claims Quality Audit Manager jobs in California

Claims Quality Audit Manager manages the claims quality auditors and daily activities of quality claims audit function. Reviews and tracks claims quality audit reports and measures performance of auditors. Being a Claims Quality Audit Manager provides assistance in developing claims audit policies and procedures. May provide coaching in complex claims audit. Additionally, Claims Quality Audit Manager typically requires a bachelor's degree. Typically reports to a director or head of a department. The Claims Quality Audit Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Claims Quality Audit Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)

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Health Claims Audit Manager
  • Withum
  • San Ramon, CA FULL_TIME
  • Looking to work at a firm with an unbeatable culture?

    Withum is a forward-thinking, technology-driven advisory and accounting firm, helping clients to Be in a Position of StrengthSM in today’s modern business landscape. Withum empowers clients with innovative tools and solutions to address their accounting, tax and overall business management needs. Withum is a place where talent thrives. We recruit only the best and brightest people, with a genuine passion for the business.

    Withum is seeking an experienced health claims auditor possessing in-depth knowledge of group health and disability claims procedures, medical/dental terminology, including CPT, ADA, HCPC and ICDA codes, and a thorough understanding of automated health claims systems as well as manual claims payment systems.

    How You’ll Spend Your Time

    • Working closely with our clients to ensure that health, dental, prescription and vision claims are being paid in compliance with regulations and plan documents
    • Reviewing client's claims adjudication internal controls policies and procedures
    • Completing audit workpapers documenting procedures, findings and conclusions within assigned budgets and deadlines
    • Responsible for scheduling and oversight of claims team (3-5 at any given time)
    • Review work of team members and present to engagement partner for their final review

    The Type's of People We Look For Have the Following Qualities:

    • BS Degree
    • Must be qualified at analyzing and interpreting group health insurance contract provisions and reviewing administrative policies and PPO contracts
    • Experience supervising staff and working within a team environment
    • Must be familiar with HIPAA and ACA compliance standards
    • Must have a minimum of 7-10 years of health claims processing experience (internal auditing skills a plus)
    • Good computer skills (Microsoft office preferred), excellent communication skills
    • Ability to travel
    • 2-4 years of managerial experience in health claims processing is a plus

    The compensation for this position will vary by location. If you reside in San Ramon, CA please see below. In addition to the base compensation, Withum offers a competitive benefits package and bonus program (for eligible roles) based on individual and firm performance. Final offer amounts are based on multiple factors such as the specific role, hiring location, as well as the individual’s skills, experience and qualifications. For additional information on our benefits, visit our website at https://www.withum.com/careers/.

    California ranges are from $90,000-$120,000 annually

    New York ranges are from $90,000-$120,000 annually

    Washington DC ranges are from $90,000-$120,000 annually

    Withum will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or because he or she is a protected veteran. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
  • 1 Day Ago

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Quality Manager
  • Quality Aluminum Forge
  • Orange, CA OTHER
  • General SummaryPlans, coordinates, and directs the quality assurance program designed to ensure continuous production of products consistent with established standards. Works closely with department s...
  • 2 Days Ago

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Audit Manager and Audit Seniors
  • Impact Solutions Inc
  • Santa Barbara, CA FULL_TIME
  • CPA Firm Audit Managers and Seniors - Hybrid living close to the office is preferred - Fully Remote Home Based is available for candidates living in the PST or MST time zones. Will assist with relocat...
  • 6 Days Ago

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Audit Manager and Audit Seniors
  • Job Juncture
  • Los Angeles, CA FULL_TIME
  • CPA Firm Audit Managers and Seniors - Hybrid living close to the office is preferred - Fully Remote Home Based is available for candidates living in the PST or MST time zones. Will assist with relocat...
  • Just Posted

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Audit Manager and Audit Seniors
  • Impact Solutions Inc
  • Woodland, CA FULL_TIME
  • CPA Firm Audit Managers and Seniors - Hybrid living close to the office is preferred - Fully Remote Home Based is available for candidates living in the PST or MST time zones. Will assist with relocat...
  • 19 Days Ago

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Audit Manager and Audit Seniors
  • Impact Solutions Inc
  • Los Angeles, CA FULL_TIME
  • CPA Firm Audit Managers and Seniors - Hybrid living close to the office is preferred - Fully Remote Home Based is available for candidates living in the PST or MST time zones. Will assist with relocat...
  • 21 Days Ago

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Final Drug Product Quality Manager
  • Takeda Pharmaceuticals
  • Thousand Oaks, CA
  • By clicking the "Apply" button, I understand that my employment application process with Takeda will commence and that t...
  • 6/11/2024 12:00:00 AM

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Product Quality Manager
  • Azienda Anonima
  • Join our international company, a leader in its field, as we seek an experienced Quality Manager. The Quality Manager en...
  • 6/10/2024 12:00:00 AM

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Product Quality Manager
  • Lockheed Martin
  • Salina, NY
  • Job ID: 665811BR Date posted: Apr. 30, 2024 Description:THE WORK Leads the RMS Syracuse Product Quality Assurance (PQA) ...
  • 6/9/2024 12:00:00 AM

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Product Quality Manager # SC044
  • Cummins
  • North Charleston, SC
  • Product Quality Manager # SC044 Description Advocate for product quality and act as an internal champion on behalf of th...
  • 6/9/2024 12:00:00 AM

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Quality Control Manager
  • Aegis Worldwide
  • Elysburg, PA
  • Responsibilities: Develop a comprehensive product quality management program (including both quality assurance and quali...
  • 6/8/2024 12:00:00 AM

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Director, Quality Audit Management
  • Ironwood Pharmaceuticals
  • Boston, MA
  • Ironwood Pharmaceuticals is a leading global gastrointestinal (GI) healthcare company on a mission to advance the treatm...
  • 6/7/2024 12:00:00 AM

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Product Quality Manager
  • Lockheed Martin
  • Liverpool, NY
  • Job Description THE WORK Leads the RMS Syracuse Product Quality Assurance (PQA) organization reporting to the Product Qu...
  • 6/7/2024 12:00:00 AM

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Quality Manager
  • Expert Connections
  • Johnson City, TN
  • Our client is a global leader in the high-performance battery separators industry. The Quality Manager will lead the eff...
  • 6/7/2024 12:00:00 AM

California is a state in the Pacific Region of the United States. With 39.6 million residents, California is the most populous U.S. state and the third-largest by area. The state capital is Sacramento. The Greater Los Angeles Area and the San Francisco Bay Area are the nation's second and fifth most populous urban regions, with 18.7 million and 9.7 million residents respectively. Los Angeles is California's most populous city, and the country's second most populous, after New York City. California also has the nation's most populous county, Los Angeles County, and its largest county by area, S...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Manager jobs
$107,191 to $144,004

Claims Quality Audit Manager in Kennewick, WA
Based on our compensation data, the estimated salary potential for Claims Quality Audit Manager will increase 16 % over 5 years.
January 17, 2020
Claims Quality Audit Manager in Canton, OH
On average, a Bachelor's Degree is the highest level of education for a Claims Quality Audit Manager.
January 04, 2020