Quality Auditor - Health Plan

Job Summary

To ensure compliance and enhance operational efficiency, the full-time Quality Auditor - Health Plan will perform routine and targeted audits across various health plan operations remotely, focusing on Claims, Grievances and Appeals, Enrollment, and Provider Data.

Key responsibilities

• Conduct operational quality audits to ensure adherence to regulatory requirements and internal policies
• Track and trend issues through SCAN's workflow system, documenting cases and resolutions accurately
• Collaborate with other business units to identify and rectify processing errors while contributing to departmental initiatives

Required qualifications

• Associate's degree preferred or equivalent experience
• 3+ years of auditing experience in health plans or managed care organizations
• Proficiency in processing/auditing for Medicare and Medicaid plans
• Strong knowledge of CMS requirements related to auditing processes
• Completion of health insurance training and medical terminology or equivalent knowledge