Quality Auditor

Job Summary

Conducting internal audits and operational quality reviews, the hybrid remote Quality Auditor will focus on claims auditing and expand to customer service interactions while ensuring compliance and consistency across operational functions.

Key responsibilities

• Conduct internal audits of healthcare claims transactions for accuracy and compliance with established standards and regulations
• Analyze audit data to identify trends and performance gaps, providing data-driven recommendations for process improvement
• Document audit results and maintain organized records, participating in quality calibration sessions to ensure consistency across the team

Required qualifications

• High School Diploma or equivalent; Associate's Degree preferred
• 1+ years of audit experience in the Health Insurance Industry, including knowledge of HIPAA and ERISA
• 1+ years of healthcare claims and/or customer service experience
• Bi-lingual in Spanish preferred
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint