Claims and QA Manager
Aither HealthJob Title: Claims and QA Manager
Status: Exempt
The Claims and QA Manager is a key leadership role responsible for overseeing the claims process and quality assurance functions within Aither Health. This individual will manage both the Claims and QA departments, ensuring accuracy, efficiency, and compliance in all claims processing activities. In addition to overseeing daily operations, this role requires strong people management skills to lead, mentor, and develop team members, driving excellence in both claims processing and quality assurance.
Primary Responsibilities would include:
Leadership & Team Management: Effectively manage the daily operations of the Claims and QA teams, ensuring high performance, accountability, and adherence to company standards. Delegate tasks and manage workloads efficiently to optimize production and service levels.
Quality Assurance & Compliance: Oversee the QA process for claims, ensuring accuracy, compliance, and adherence to internal and regulatory guidelines. Provide coaching and corrective feedback to maintain high-quality outcomes.
Operational Oversight: Maintain full responsibility for the claims processing workflow, ensuring timely and accurate claims adjudication. Monitor key performance metrics and implement process improvements where needed.
Collaboration & Relationship Management: Foster strong working relationships with internal and external teams.
Training & Development: Provide ongoing coaching, performance evaluations, and professional development opportunities for Claims and QA team members. Conduct regular one-on-one meetings to support employee growth and performance.
Process Improvement & Problem-Solving: Identify inefficiencies and implement process enhancements to improve workflows, productivity, and claim accuracy. Engage in proactive problem-solving and process refinement initiatives.
Client & Internal Reporting: Coordinate and manage reporting functions related to claims and quality assurance, working closely with internal departments to ensure transparency and accountability.
Standard Operating Procedures (SOPs): Assist in the development, documentation, and refinement of SOPs to standardize processes and improve departmental efficiency.
New Employee Onboarding: Support the training and integration of new team members, ensuring they understand company policies, workflows, and expectations.
Other Duties: Perform additional related responsibilities as assigned to support department and organizational goals.
What you’ll bring:
Minimum 2 years of experience managing a claims department and team members.
3-7 years of TPA industry experience with a strong understanding of healthcare claims administration.
Proven leadership ability with a track record of mentoring and developing teams.
Strong communication skills (both written and verbal) with the ability to clearly convey information.
Experience in hiring, training, and managing teams.
Ability to analyze data, identify trends, and implement effective solutions.
Strong organizational skills with the ability to prioritize tasks and manage multiple responsibilities.
Detail-oriented mindset with a commitment to accuracy and quality.
Problem-solving skills and a proactive approach to improving workflows.
Ability to maintain confidentiality and handle sensitive information responsibly.
Team-player mentality with a willingness to contribute beyond core responsibilities as needed.
Availability to work Monday-Friday, 8:30 AM - 5:00 PM EST, with flexibility for additional hours as needed.
Associate's or Bachelor's degree preferred, or equivalent industry experience.
Compensation Range: $65,000-$85,000
Physical Requirements:
Prolonged period sitting at a desk and working on a computer and the ability to lift 15 pounds.
As an Equal Opportunity / Affirmative Action Employer, Aither Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Aither Health will not tolerate discrimination or harassment based on any of these characteristics. Aither Health encourages applicants of all ages.
Requirements
Minimum 2 years of experience managing a claims department and team members.
3-7 years of TPA industry experience with a strong understanding of healthcare claims administration.
Proven leadership ability with a track record of mentoring and developing teams.
Strong communication skills (both written and verbal) with the ability to clearly convey information.
Experience in hiring, training, and managing teams.
Ability to analyze data, identify trends, and implement effective solutions.
Strong organizational skills with the ability to prioritize tasks and manage multiple responsibilities.
Detail-oriented mindset with a commitment to accuracy and quality.
Problem-solving skills and a proactive approach to improving workflows.
Ability to maintain confidentiality and handle sensitive information responsibly.
Team-player mentality with a willingness to contribute beyond core responsibilities as needed.
Availability to work Monday-Friday, 8:30 AM - 5:00 PM EST, with flexibility for additional hours as needed.
Associate's or Bachelor's degree preferred, or equivalent industry experience.