Claims Quality Assurance Supervisor

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant focus lead the way no matter what. The Claims Quality Assurance Supervisor is responsible for developing and overseeing a group of para-professional level team members to ensure accuracy, efficiency, and compliance with contractual and regulatory requirements of processed claims on a pre and post pay basis. This position is a member of the WelbeHealth management team and facilitates collaborative relationships across WelbeHealth and with external stakeholders to promote WelbeHealth values, team culture and mission. This role is different because the Claims Quality Assurance Supervisor WelbeHealth: • Leads claims quality assurance strategy and execution, ensuring accurate and timely claims payments while maintaining compliance with Medicare, Medicaid, contractual, and regulatory requirements across a growing healthcare organization. • Drives continuous improvement through data-driven auditing, trend analysis, and cross-functional collaboration, while developing team members, strengthening workflows, and implementing quality standards that support operational excellence and accurate claims processing. We care about our team members. That’s why we offer: • Medical insurance coverage (Medical, Dental, Vision) • Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days • 401K savings + match • Comprehensive compensation package including base pay and bonus • And additional benefits! On the day-to-day, you will: • Oversee auditing activities that claims are paid in an accurate and timely manner and in accordance with internal and external regulations and guidelines • Identify issues and operational gaps, develop solutions, and make recommendations for improvement regarding processing and training • Track progress and communicating audits results/status on a regular basis to impact parties • Make recommendations related to identified trends or improvements, and work with management and team members in other departments to implement changes, as directed by identified trends • Create and update team procedures, workflows, and resource materials • Monitor the results of daily team member activities, report critical issues and/or concerns to management • Serve as the primary resource and point of escalation of issues related to quality assurance • Provide direct supervision, support, and guidance to team members • Evaluate team member performance, provide feedback, coaching and counseling when performance issues arise. Identify training gaps and opportunities for improved performance Job requirements include: • Associates degree preferred or relevant professional experience in a health plan environment with an emphasis on billing, claims payment, coding and/or other closely related functions may be substituted • Minimum of five (5) years’ experience in health plans, i.e., managed care or PACE strongly preferred • Experience in claims processing environment, with an emphasis on claims auditing • Progressively responsible experience with demonstrated ability to mentor team members required • Working knowledge in Medicare and/or Medicaid billing and guidelines and ability to understand and analyze contractual and regulatory requirements and their effect on claims payment and resolutions • Ability to process accurate information in a timely manner; Excellent leadership, organizational and communication skills • Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects; Comprehensive knowledge of claims processing and regulation