Claims Quality Control Auditor

The Claims Quality Control Auditor ensures organizational claim processing complies with contractual and regulatory requirements. The position performs audit functions for internal and external clients, provides training standards based on findings, creates statistical auditing reports for management, and recommends process improvements to maximize accuracy.

What You Will Do

Responsibilities include reviewing claim process functions, adhering to internal processes, identifying trends and patterns in errors, preparing written reports on audit findings, and advising external departments with claims research and processing issues.

Why It Might Be a Fit

The ideal candidate will have experience in medical billing or claim processing, data analytics skills, and the ability to read, understand, and apply contract terms to claims processing and quality audits.

Requirements

• Associates Degree or equivalent relevant work experience
• Minimum 1-3 years directly related experience in medical billing or claim processing
• Capable of performing mathematical functions
• Intermediate to Advanced skills in Microsoft Office Suite
• Data analytics experience
• Ability to read, understand, and apply contract terms to claims processing and quality audits
• Excellent communications skills
• Ability to work both independently and in a team-based environment
• Ability to manage multiple projects simultaneously
• Must exercise excellent judgment and be effective working autonomously and as part of a team
• Exceptional listening skills and verbal/written communication skills
• Problem solver with strong attention to detail

Benefits

• Equal opportunity employer
• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status