HealthEdge

Sr. Manager, Quality Audit

HealthEdge$155K — $165K *
US-AnywhereRemote in United States
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor’s Degree in Business, Health Services Administration, or related field
  • Minimum of 8 years of progressive management experience in health plan operations
  • Strong understanding of claims processing
  • 5-7 years Medicare Advantage experience preferred
  • Experience managing/supervising employees

Responsibilities

  • Plan, develop, and evaluate all onshore and offshore BPaaS activities
  • Collaborate with stakeholders across functions to ensure customer success
  • Establish objectives, policies, and procedures for compliance
  • Develop and execute strategies to achieve key performance measures
  • Identify and implement new processes and technologies to streamline operations
  • Administer the department budget
  • Provide Executive level briefings to senior leadership

Benefits

  • Remote work flexibility across the US
  • Full-time permanent position
  • Opportunity to work with a diverse group of stakeholders
  • Engagement with senior leadership
  • Ability to influence operational strategies
Full Job Description
Overview

UST HealthProof is looking for a Director of Business Operations who under the general supervision of the Vice President of Operations, will be responsible for leading strategies to enhance business performance and outcomes.  In this role, you will plan, direct, coordinate, and oversee operational activities to ensure efficient operations and cost-effective systems to meet current and future customer needs. 

The Candidate should have excellent communication skills and the ability to engage with leaders across the organization. 

As a Group Manager, Business Operations; you will be responsible for the following:

  • Plan, develop, organize, direct and evaluate all aspects of onshore and offshore BPaaS activities
  • Serve alongside multiple stakeholders, including Configuration, IT Operations, Contact Center Operations, and Medical Management to deliver customer success
  • Establish operational objectives, policies and procedures ensuring compliance with customer contracts and related laws and regulations
  • Develop and execute strategies to achieve key performance measures
  • Identify, recommend, and implement new processes, technologies, and systems to improve and streamline processes and use of resources
  • Establish and administer the department budget
  • Provide Executive level briefings to Senior Leadership at regular intervals to keep leadership current with updates and performance levels
  • Establish strong, collaborative relationships with client leadership
  • Comply with the organization’s Code of Conduct; all regulatory and contractual requirements; organizational policies; procedures; and internal controls

You bring:

  • Bachelor’s Degree in Business, Health Services Administration, or related field
  • A minimum of 8 years of progressive management experience in health plan operations, with a strong understanding of claims processing
  • 5 – 7 years Medicare Advantage experience preferred
  • Experience managing/supervising employees

Geographic Responsibility:  Remote, US

Type of Employment: Full-time, permanent 

FLSA Classification (USA Only): Exempt 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

  • The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.  

  • Work across multiple time zones in a hybrid or remote work environment. 

  • Long periods of time sitting and/or standing in front of a computer using video technology. 

  • May require travel dependent on company needs. 

 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check. 

 

#LI-Remote 

 

**The annual US base salary range for this position is $155,000 to $165,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.  

About HealthEdge

HealthEdge is a healthcare technology company that provides next-generation core administrative systems, advanced analytics, and engagement tools that enable healthcare organizations to reduce costs, improve outcomes, and enhance the member experience. The company's innovative solutions are built on modern, patented technology and delivered to customers via the HealthRules platform, which is designed to be highly flexible, scalable, and configurable to meet the unique needs of each customer. HealthEdge's customers include health plans, third-party administrators, and self-insured employers.
Learn more about HealthEdge
Size
500 employees
Industry
Founded
2004

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