Claims Quality Inspector

Job Summary

A company is looking for a Claims Quality Inspector.

Key Responsibilities:

• Conduct accurate and timely quality reviews of claim adjudication activities
• Perform quality audits on Membership eligibility and enrollment entry
• Document findings in QC tracking system and communicate error determinations

Required Qualifications:

• High School Diploma or GED required
• At least 2 years of experience in a Claims or QC/Inspector role within the managed care industry, or 5 years processing medical claims
• Bachelor's degree and/or Claims adjudication or medical billing/coding certification preferred
• Prior experience within the Medicare, Medicaid, or regulated Managed Care payer environment is desirable
• Pre-employment background check required