Senior Quality Auditor

Job Summary

To support the needs of the business, the full-time Senior Quality Auditor will develop and implement effective business solutions through research and analysis of data, while auditing provider data and claims processing systems remotely.

Key responsibilities

• Audit and validate routine pre and post payment claims for compliance with corporate policies and regulatory guidelines
• Research claims and enrollment discrepancies related to provider data and summarize findings in reports for management
• Maintain department statistics for quality improvement and communicate audit results to enhance claims processing

Required qualifications

• High School Diploma or equivalent; some college coursework preferred
• Four years of general data management experience in an automated claims processing, claims research, or provider maintenance environment
• Advanced knowledge of provider files and their relation to claims processing systems