At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design.

This role oversees the Customer Experience Quality Assurance Program, responsible for the day-to-day oversight of the Collective Health Quality Assurance Program (QAP).  This team plays a vital role in ensuring the accuracy, timeliness, and efficiency of claims processing for our employer-sponsored medical plans while addressing complex claims scenarios and maintaining compliance with regulatory and operational requirements.

• Key responsibilities of the QAP Manager include:

• Creating and implementing the Collective Health QA Program with the goals of safeguarding claims financial and procedural accuracy according to the health benefit plan’s intent.
• Developing, implementing and ensuring through reporting tools and resources  compliance with regulatory requirements, including monitoring for fraud, waste and abuse activities.
• Establishing and maintaining network and business partner relationships by collaborating and educating business associates on billing patterns that need improvement.
• Performing routine, moderate and complex ...