Claims Quality Auditor

Quality Assurance Auditor

POSITION SUMMARY

Working independently and in groups the Quality Assurance Auditor will be responsible for the completion of multiple audit tasks including but not limited to auditing provider and eligibility matched claims, paper batch, and data captured claims, along with compiling and reporting results and trends accurately. The QA Auditor is also responsible for ensuring compliance with established internal control procedures by examining records, reports, operating practices, and documentation.

ESSENTIAL FUNCTIONS
? Log and track data to be audited
? Communicate and coordinate with other departments involved in the audit process
? Assist with current audit programs in place as well as identify ways to improve audit results
? Track and report audit trends and communicate training requirements to Management based on audit results
? Monitor and track audit progress to ensure all audit task are complete by the determined deadline
? Audit data for accuracy as well as workflow compliance
? Other duties as assigned

EDUCATION
? Bachelor's degree or equivalent work experience required.

EXPERIENCE & SKILLS
? Minimum 5 years of comprehensive experience with auditing medical, dental, and vision claims required.
? Proficient in Microsoft Word and Microsoft Excel
? Strong written and verbal communication skills required
? Ability to effectively manage assigned workload, including multiple task and competing priorities

COMPETENCIES
? Job Knowledge
? Time Management
? Accountability
? Communication
? Initiative
? Customer Focus

PHYSICAL DEMANDS
? This is an office environment requiring extended sitting and computer work

WORK ENVIRONMENT
? Remote

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

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