Quality Auditor

Job Summary

Auditing second level appeals of claims, the full-time Quality Auditor will ensure compliance with contract requirements, perform user testing, and analyze data to identify improvement opportunities, all while working remotely.

Key responsibilities

• Conduct audits and examinations of case files to identify inaccuracies and compliance issues
• Provide educational feedback and insights to staff based on audit findings
• Assist in data analysis to improve the appeals process and reduce unnecessary appeals

Required qualifications

• High School Diploma or equivalent
• Three years of general office experience, with potential substitution by relevant education
• One year of experience in Qualified Independent Contractor (QIC) appeals or healthcare appeals processes
• Preferred experience with Medicare Part C related appeals activities
• Residency in the United States for at least three of the last five years