Claims Quality Auditor

Job Summary

A company is looking for a Claims Quality Auditor.

Key Responsibilities

• Conduct pre-payment, post-payment, and auto-adjudication audits on medical claims
• Ensure accuracy of claims processing and financials according to regulatory requirements and standard procedures
• Track and report audit results, identifying trends and areas for process improvement

Required Qualifications

• Bachelor's Degree or equivalent work experience
• 2 years of experience auditing medical claims for a health insurer or TPA
• 5 years of extensive medical claims processing background
• Core system configuration knowledge
• Ability to analyze data and recognize trends using root cause analysis techniques