Quality Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct audits on transactions completed by health plan administration associates for a designated customer.

• Ensure adherence to the customer quality processes and tools during the audit and rebuttal procedures.

• Communicate QA findings with individual associates and collaborate with operational Team Leads and managers to deliver constructive feedback, clearly identifying errors and areas for improvement.

• Gather, compile, and report both team and individual associates’ QA performance metrics to management and the individuals involved.

• Offer insights to the Training team and Team Leads regarding current written processing instructions and refresher training requirements.

• Engage in semi-annual or annual calibration activities for auditors.

• Stay updated on CMS claims processing regulations and guidelines relevant to Medicare Advantage organizations and ACA Exchange and Off Exchange lines of business.

⛳️ Requirements

• A High School Diploma or GED is mandatory.

• A minimum of 3 years of experience in health plan claims auditing operations is essential.

• Experience in auditing Medicare claims is preferred.

• Proficiency in MS Suite, particularly Excel, PowerPoint, and Outlook, is required.

• Familiarity with HealthRules Payor or Guiding Care is preferred.

• Capability to analyze contractual SLAs and KPIs is necessary.

• Strong communication and collaboration skills, especially when working with a remote team.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and training.

• Flexible work arrangements.