Job Description: The Senior Executive - Quality Management - Claims will play a crucial role in ensuring the accuracy and efficiency of the claims process. They will be responsible for overseeing and improving the quality of claims handling, working closely with the Facet application to streamline operations. This role is an excellent opportunity for an experienced professional to contribute to the success of our Large Payer healthcare domain.
- Responsibilities: Oversee and manage the quality of claims handling processes.
- Utilize Facet application to optimize and streamline claims adjudication.
- Ensure compliance with regulatory standards and internal policies.
- Review and analyze claims data to identify areas for improvement.
- Implement quality control measures and best practices.
- Collaborate with the claims team to resolve complex issues.
- Provide training and support to team members on quality management.
- Maintain accurate records and documentation for audits.
- Stay updated with industry trends and best practices in healthcare claims.
- Contribute to the development of strategic initiatives for quality improvement.
- Qualifications: Bachelor's degree or equivalent in a relevant field.
- Minimum 2 years of experience in healthcare claims or claims adjudication.
- Hands-on experience with Facet application is mandatory.
- Strong knowledge of healthcare industry regulations and standards.
- Excellent analytical and problem-solving skills.
- Attention to detail and a commitment to accuracy.
- Effective communication and interpersonal skills.
- Ability to work collaboratively in a team environment.
- Proficiency in MS Office and relevant software tools.
- Willingness to work in a night shift schedule.
