Claims Quality Assurance Supervisor

WelbeHealth

. Develop and oversee a group of para-professional level team members .

Posted 10/30/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $99,310 - $131,089 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims processing, auditing, and regulatory compliance within health plans, while effectively leading and developing team members to achieve operational excellence. Strong analytical and problem-solving skills are essential for identifying trends and implementing improvements.

Highest-signal resume keywords

Claims ProcessingQuality Assurance StrategyMedicare And Medicaid ComplianceTeam Leadership And DevelopmentData-Driven Auditing

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AuditingBilling And CodingRegulatory ComplianceTrend AnalysisOperational ImprovementData AnalysisPerformance EvaluationWorkflow DevelopmentProblem SolvingContractual Requirements Analysis

Soft Skills

LeadershipOrganizational SkillsCommunication SkillsCoachingMentoring

Certifications & Qualifications

COVID-19 Vaccination Proof

Industry Keywords

Health PlansManaged CarePACEClaims PaymentOperational Excellence

About the role

Key responsibilities & impact

Develop and oversee a group of para-professional level team members
Lead claims quality assurance strategy and execution
Ensure accurate and timely claims payments while maintaining Medicare, Medicaid, contractual, and regulatory compliance
Drive continuous improvement through data-driven auditing, trend analysis, and cross-functional collaboration
Develop team members and strengthen workflows
Implement quality standards supporting operational excellence and accurate claims processing
Oversee auditing activities for accurate and timely claims payment
Identify operational issues and gaps, develop solutions, and recommend improvements to processing and training
Track progress and communicate audit results/status regularly to impacted parties
Recommend improvements based on identified trends and work with management and other departments to implement changes
Create and update team procedures, workflows, and resource materials
Monitor daily team member activities and report critical issues or concerns to management
Serve as primary resource and escalation point for quality assurance issues
Provide direct supervision, support, and guidance to team members
Evaluate performance and provide feedback, coaching, and counseling
Identify training gaps and opportunities for improved performance

Requirements

What you’ll need

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
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 regulations
Strong problem solving skills and ability to analyze problems and formulate solutions
Proof of COVID-19 vaccination or a vaccine declination form required prior to employment

Benefits

Comp & perks

Medical insurance coverage (Medical, Dental, Vision)
17 days of personal time off (PTO)
12 holidays observed annually
6 sick days
401K savings + match
Comprehensive compensation package including base pay and bonus
Additional benefits
COVID-19 vaccination policy and infection control/PPE standards