As the Lead Claims Quality Auditor, you will lead a team focused on maintaining the highest standards in claims processing. You'll ensure audits are completed accurately and on time, aligned with established policies and client-specific guidelines, while fostering a culture of accountability, growth, and precision.
What You'll Do
You'll manage the end-to-end quality assurance process, overseeing daily operations and guiding team performance. This includes reviewing claim audits for procedural and monetary accuracy, tracking results against SLAs, and generating detailed reports that highlight error patterns and decision logic. You'll analyze trends to uncover systemic issues and work closely with leadership and training teams to implement corrective actions. Your role will also involve coaching team members, developing performance improvement plans, and contributing to training initiatives that elevate overall team capability.
Requirements
- High School diploma or GED required
- Minimum of 3 years in claims examination or quality assurance within a healthcare setting
- Demonstrated ability to interpret complex plan documents and apply them to audit processes
- Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
- Excellent written and verbal communication skills, with a focus on clarity and professionalism
- Proficiency in MS Office, including Word, Excel, Outlook, and PowerPoint
- Experience with automated claims adjudication systems
- Ability to work independently, lead others, and escalate critical issues appropriately
- Skilled in identifying root causes and driving quality improvement initiatives
Benefits
This role operates in a hybrid model, with options for in-person, hybrid, or remote work based on location. Candidates near Buffalo, NY, or New York City, NY, will have access to office resources and collaborative environments. An Associate or Bachelor’s degree is preferred but not required. The position supports professional development through mentorship, performance feedback, and opportunities to influence process design.
