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Job Description
The Health Insurance QA Manager is responsible for ensuring that claims, case processes, and services meet established standards to guarantee efficiency, mitigate losses, and prepare controls for managing claims costs.
Resolve difficult client enquiries:
KEY TASKS AND RESPONSIBILITIES Quality Audits Of Claims.
Conduct an audit of overall claims settled, placing special attention to high-value, repeated visits, and duplicate claims. Check error rate.
Identify Providers with significant billing irregularities or suspected of fraud and have regular provider engagements issues on billing.
At the end stage of provider reconciliation, claims that relate to benefit excesses are to be reviewed and liability assigned to either UAP, client/scheme or Smart.
Admissions tracking; checking on exaggerated bills, unnecessa...