Claims Operations Supervisor

A company is looking for a Claims Operations Delegation Oversight Supervisor. Key Responsibilities Manage all Claims external audits and requests for information, ensuring accuracy and compliance Develop and maintain monitoring tools to identify and correct potential non-compliant claims Collaborate with internal teams to create KPI reporting and assist in root cause analysis for corrective action plans Required Qualifications 2-3+ years of experience in claims operations with a focus on compliance/operations Experience in delegation oversight within a health plan or MSO Knowledge of Medi-Cal and Medicare regulations Experience reading corrective action plans (CAPs) Familiarity with regulatory requirements in the healthcare industry

Mar 24, 2025 - 19:03

A company is looking for a Claims Operations Delegation Oversight Supervisor. Key Responsibilities Manage all Claims external audits and requests for information, ensuring accuracy and compliance Develop and maintain monitoring tools to identify and correct potential non-compliant claims Collaborate with internal teams to create KPI reporting and assist in root cause analysis for corrective action plans Required Qualifications 2-3+ years of experience in claims operations with a focus on compliance/operations Experience in delegation oversight within a health plan or MSO Knowledge of Medi-Cal and Medicare regulations Experience reading corrective action plans (CAPs) Familiarity with regulatory requirements in the healthcare industry