Senior Claims Quality Assurance Manager
1 month ago
About the Role
Alight is seeking an experienced Senior Claims Quality Assurance Manager to join our team. This role will play a critical part in ensuring the quality and efficiency of claims processing operations.
Responsibilities
- Strategic Leadership: Direct and oversee the quality and training function for claims operations, working closely with the Operations Leader to establish standardized policies and procedures.
- Quality Assurance: Develop and implement quality assurance processes to enhance claims handling efficiency and accuracy, monitoring claims processing and reviewing outcomes to identify areas for improvement.
- Performance Metrics: Define and track key performance indicators (KPIs) related to claims quality, turnaround time, and customer satisfaction, analyzing data to drive continuous improvement initiatives.
- Staff Training and Development: Provide expert guidance and consultation to staff on complex claims scenarios, conducting training sessions to enhance technical skills and domain knowledge.
- Risk Management: Mitigate risks associated with claims processing errors, fraud, and non-compliance, implementing preventive measures and corrective actions.
- Budgeting and Resource Allocation: Develop and manage budgets for quality assurance programs, allocating resources effectively to achieve quality objectives.
- Process Optimization: Identify bottlenecks and streamline claims workflows, implementing technology solutions to enhance efficiency through automation.
Requirements
- Masters/Bachelor's degree in a relevant field (e.g., Business Administration, Insurance, Quality Management).
- Minimum 8-10 years of managerial experience in claims operations or quality management, with a deep understanding of claims processes, insurance policies, and risk assessment.
- Strong analytical skills and attention to detail, excellent communication and leadership abilities, proficiency in using claims management software and data analytics tools.
- MBB Certification in quality management (e.g., Six Sigma, Lean) is a must have.
What We Offer
We offer a competitive total rewards package, including a salary range of $120,000 - $160,000 per year, depending on location and experience. In addition, we provide continuing education and training opportunities, as well as a comprehensive benefits program that includes health coverage options, wellbeing and support programs, retirement plans, vacation and sick leave, maternity, paternity & adoption leave, and more. Alight is committed to diversity, equity, and inclusion, and welcomes applications from qualified candidates who share our values.
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