3 regional quality assurance manager jobs found

Job Description: Summary: The Claims Examiner resolves a wide variety of claims transactions that may include, but not limited to, entry, adjudication or adjusting simple or complex claims in accordance with Member Touchpoint Measures (MTM), Inter-Plan Scorecard, FEP Performance Incentive Plan (PIP), Corporate Policies, National Committee of Quality Assurance (NCQA) and mandated requirements. Essential Accountabilities: Level I • Handle front end transactions including but may not be limited to member eligibility, entry of claims, member & provider matching and claim processing. • Identify patterns that impact quality, claim inventory, and/or the customer experience and escalate for review. • Identify potential trends and if necessary, escalate for investigation/solution. • In accordance with established departmental procedures, corporate policies, member, group, and provider contracts and riders: o Process, enter, adjudicate and/or adjust and research claims. o...

Job Description: Summary: The Claims Examiner resolves a wide variety of claims transactions that may include, but not limited to, entry, adjudication or adjusting simple or complex claims in accordance with Member Touchpoint Measures (MTM), Inter-Plan Scorecard, FEP Performance Incentive Plan (PIP), Corporate Policies, National Committee of Quality Assurance (NCQA) and mandated requirements. Essential Accountabilities: Level I • Handle front end transactions including but may not be limited to member eligibility, entry of claims, member & provider matching and claim processing. • Identify patterns that impact quality, claim inventory, and/or the customer experience and escalate for review. • Identify potential trends and if necessary, escalate for investigation/solution. • In accordance with established departmental procedures, corporate policies, member, group, and provider contracts and riders: o Process, enter, adjudicate and/or adjust and research claims. o...

Job Description: Summary: The Claims Examiner resolves a wide variety of claims transactions that may include, but not limited to, entry, adjudication or adjusting simple or complex claims in accordance with Member Touchpoint Measures (MTM), Inter-Plan Scorecard, FEP Performance Incentive Plan (PIP), Corporate Policies, National Committee of Quality Assurance (NCQA) and mandated requirements. Essential Accountabilities: Level I •\tHandle front end transactions including but may not be limited to member eligibility, entry of claims, member & provider matching and claim processing. •\tIdentify patterns that impact quality, claim inventory, and/or the customer experience and escalate for review. •\tIdentify potential trends and if necessary, escalate for investigation/solution. •\tIn accordance with established departmental procedures, corporate policies, member, group, and provider contracts and riders: o\tProcess, enter, adjudicate and/or adjust and research claims....