Senior Quality Auditor

Job Summary

To develop and implement effective business solutions, the full-time Senior Quality Auditor will conduct audits of provider data and claims processing systems, ensuring compliance with corporate policies and regulatory guidelines while working remotely within the continental United States.

Key responsibilities

• Audits and validates pre and post payment claims for correct adjudication and compliance
• Researches claims and enrollment discrepancies related to provider data and summarizes findings in reports
• Maintains department statistics for quality improvement and communicates results to enhance claims processing

Required qualifications

• High School Diploma or equivalent; some college coursework preferred
• Four years of general data management experience in claims processing or provider maintenance
• Advanced knowledge of provider files and their relation to claims processing systems
• Current working knowledge of health insurance industry regulations and certification standards
• Experience in auditing and analyzing business processes and data