Director of Claims Quality - Hybrid (NYC)

***MUST HAVE MANAGED CARE EXPERIENCE WITHIN NYS HEALTHCARE PROVIDER NETWORKS***

The Director of Claims Quality has responsibility for the creation, delivery, and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance oversight program, which includes defining frameworks/benchmarks, calibration, and reporting of a program towards set benchmarks while promoting a continuous improvement culture.

Furthermore, the Director of Claims Quality is responsible for the management/oversight of claims quality, claims compliance, training and remediation, user acceptance testing (UAT), claims adjustments, and correspondence/inquiries/reconsiderations/appeals. This includes overseeing staffing, implementing, and maintaining policies, procedures, and workflows across the Claims department that is compliant with all applicable Local, State, and Federal Regulations. Also, this position is responsible for developing and enhancing...