At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant focus lead the way no matter what.

The Claims Quality Assurance Supervisor is accountable for developing and overseeing a group of para-professional level team members to ensure accuracy, efficiency, and compliance with contractual and regulatory requirements of processed claims on a pre and post pay basis.

This role is different because the Claims Quality Assurance Supervisor WelbeHealth

Leads claims quality assurance strategy and execution, ensuring accurate and timely claims payments while maintaining compliance with Medicare, Medicaid, contractual, and regulatory requirements across a growing healthcare organization
Drives continuous improvement through data-driven auditing, trend analysis, and cross-functional collaboration, while developing team members, strengthening workflows, and implementing quality standards that support operational excellence and accurate claims processing

We care about our team members. That’s why we offer

Medical insurance coverage (Medical, Dental, Vision)
Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
401K savings + match
Comprehensive compensation package including base pay and bonus
And additional benefits!

On the day-to-day, you will

Oversee auditing activities, that claims are paid in an accurate and timely manner and in accordance with internal and external regulations and guidelines
Identify issues and operational gaps, develop solutions, and make recommendations for improvement regarding processing and training
Track progress and communicate audit results on a regular basis to impact parties
Make recommendations related to identified trends or improvements, and work with management and team members in other departments to implement changes as directed by identified trends
Create and update team procedures, workflows, and resource materials
Monitor the results of daily team member activities, reporting critical issues and concerns to management, as well as serve as the primary point of escalation for issues related to quality assurance
Evaluate team member performance and provide feedback, coaching, and counseling when performance issues arise, as well as identify training gaps and opportunities for improved performance

Job requirements include

Associate’s degree preferred; relevant professional experience in a health plan environment with an emphasis on billing, claims payment, coding or other closely related functions may be substituted
Minimum of five (5) years of experience in health plans; managed care or PACE strongly preferred
Experience in a 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 Medicaid billing and guidelines, and the ability to understand and analyze contractual and regulatory requirements and their effect on claims payment and resolutions
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 the ability to analyze problems and formulate solutions

We’re seeking a strategic, detail-oriented Claims Quality Assurance Supervisor who is passionate about claims accuracy, regulatory compliance, and continuous improvement. If you’re ready to join a team that values both its participants and team members, we’d love to hear from you!

Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

Compensation Offering

$99,309.58—$131,088.64 USD