Claims Quality Auditor

Job Summary

A company is looking for a Claims Quality Auditor.

Key Responsibilities

• Perform audits of transactions processed by health plan administration associates
• Share quality assurance results with associates and provide feedback on errors and improvement opportunities
• Maintain current knowledge of CMS claims processing rules and guidelines for relevant health plans

Required Qualifications

• High School Diploma or GED required
• 3 years of health plan claims auditing operations experience required
• Medicaid claims auditing experience preferred
• Proficiency in MS Suite, especially Excel, PowerPoint, and Outlook
• Ability to analyze contractual SLAs and KPIs