Someone who has come into a health plan and assisted with redefining auding practices and audit strategy, processes, benchmarking, team size etc., to reimplement audit protocols and team to address claims quality/payment integrity issues is the ideal experience.
The primary focus is on Call Center Quality Assurance audits, covering both internal and external centers.
Additionally, there are some quality assurance audits for Claims.
Someone who has been a Call Center Manager, Sr. Manager, or Director at a Health Plan.
Someone who has significant QA/Audit experience related to individual calls, setting KPIs, and focused on call center QA audits and implementing effective strategies, that have been instrumental in improving healthcare claims payment integrity and driving success in call center operations.