Manager Claims Internal Quality Audit

The Manager of Internal Quality Audit is responsible for ensuring compliance with company policies and state and federal regulations through effective internal audits. This includes staying updated on regulatory changes that may impact auditing processes.

The manager aims to maximize the effectiveness of audits in improving overall quality within the organization. This involves identifying areas for improvement and implementing corrective actions based on audit findings. Additionally, the Manager monitors the auditing process and ensures audits are thorough, objective, and conducted according to established standards and procedures.

Responsible for identifying opportunities for departmental optimization, by streamlining processes, improving communication channels, or enhancing training programs based on audit insights. Specifically overseeing audits related to pre and post-pay Claims & PDR Audits. Focus areas include accuracy in claim determination, procedural, dollar, and clerical accuracy.

Ensures that departmental and individual performance targets are met or exceeded. The manager leads efforts in root cause analysis, generating and monitoring key performance metrics and reports. Overall, the Manager of Internal Quality Audit plays a pivotal role in ensuring that the department operates with high standards of compliance, efficiency, and quality through effective auditing practices and continuous improvement initiatives.