Claims Quality Audit Manager jobs in Florida

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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Medical Case Manager
  • Medical Audit Professionals
  • Miami, FL CONTRACTOR
  • Immediate vacancy available. We are looking for a foreign medical graduate ( ONLY), Spanish, English speaker, and or other languages with an excellent work ethic in Miami Florida geographical area. no experience is required. we will train. computer multitask skills required to deal with emergencies.

    Open position night shift/or day shift schedule available:
    • A full-time job 8 hrs shift ---m-f : 05pm est- 100am est ( 40hrs/week or).
    • A Day-time job 8 hrs shift ---m-f : 09am est- 0500pm est ( 40hrs/week).
    • Both shifts require availability to be on-call - must be able to be on-call from 100 am est--900 am est 2 nights/week remotely.
    • Must be able to be oncall remotely 2 weekends/ month from friday 100am est- monday 900am est monitoring /answering emergency emails, calls, case managing emergencies, etc..
    • Any Worked hours during OnCall will be paid on an hourly after-hours rate basis as additional to the base payment.

    At the Operation office in the Miami Shores area.

    Once the candidate passes the proper paid training (2-3 WEEKS), the candidate will be working at the office and remotely. if dropped out of training without 30 days' notice. hours spent in training will be voided and paid. 

    The right candidate must be a foreign medical graduate initially, have the ability to start immediately working and handling medical benefits verification and medical pre-authorization service, inpatient care review, itemized bill review, must be able to cover phone calls during their shifts. In addition, the candidate must have excellent verbal communication skills, computer proficiency, and customer service experience.

    Responsibilities:
    • Answer inbound calls.
    • eMail monitoring average 70 eMails per day.
    • Handle providers inquiries for benefit verification.
    • Manage and resolve customer complaints.
    • Provide customers pre-authorization for medical services.
    • Medical records review.
    • itemized Bill Review.
    • Escalate priority issues.
    • Document all activities and call information according to standard operating procedures.
    • Reviewing medical records and assess for pre-existing condition and relevant exclusions on the policy.

    Core Competencies:
    • Must be Foreign Medical Graduate.
    • Must have not passed USMLE STEP1 STEP 2 Nor CSA.
    • Verbal and written communication skills ( English & Spanish, other languages) are welcomed.
    • MS Access/Word/Excel proficiency.
    • Listening skills.
    • Problem-solving.
    • Customer service oriented.
    • Organizational skills.
    • Detail-oriented.
    • Adaptability.
    • Team player.
    • Resilience.

    Job Type:
    • Full-time, Contract hourly-paid $16.00 -$24.00/Hr.

    Language:
    • Spanish and English (required) and Portuguese (preferred), any other languages are welcomed in addition to the required ones.
  • 1 Month Ago

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Manager Quality and Claims
  • Sheffield Metals International
  • Orlando, FL FULL_TIME
  • Job DescriptionManager, Quality and ClaimsThe preferred location for this position is Dallas/Fort Worth/Arlington, Atlanta or Orlando.The Quality and Claims Manager is a key member of the Sheffield Me...
  • 19 Days Ago

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Audit Manager-Quality Assurance Candidate
  • North Star Staffing Solutions
  • Fort Lauderdale, FL FULL_TIME
  • Company DescriptionNorth Star Staffing Solutions is a full lifecycle recruiting company for clients based nationwide. We specialize in placing experienced candidates in industries such as Accounting/B...
  • 21 Days Ago

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Audit Manager - IA Quality Assurance (Compliance)
  • Citi
  • TAMPA, FL OTHER
  • Citi's Internal Audit (IA) division provides independent assessments of the company's governance, risk management and internal control environment for key stakeholders including the Board of Directors...
  • 20 Days Ago

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Telesales Manager/Supervisor
  • European Consumer Claims (ECC)
  • Orlando, FL FULL_TIME
  • American Consumer Claims seeks a team member to infuse European Consumer Claims DNA into the US market. As the industry leader in Europe, we made headlines in the UK last year, cancelling over 2,800 t...
  • 19 Days Ago

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Claims Quality Assurance Specialist
  • Frontline Insurance
  • Lake, FL FULL_TIME
  • Join our dynamic team of innovators, creators, and problem solvers! At Frontline Insurance, we're on a mission to Make Things Better! We believe in fostering a collaborative, inclusive, and growth-ori...
  • 18 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

Florida (/ˈflɒrɪdə/ (listen); Spanish for "land of flowers") is the southernmost contiguous state in the United States. The state is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Atlantic Ocean, and to the south by the Straits of Florida. Florida is the 22nd-most extensive (65,755 sq mi or 170,300 km2), the 3rd-most populous (21,312,211 inhabitants), and the 8th-most densely populated (384.3/sq mi or 148.4/km2) of the U.S. states. Jacksonville is the most populous municipality in the state and the largest city by area in th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Manager jobs
$92,322 to $124,029

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