Senior Quality Auditor

A company is looking for a Senior Quality Auditor to develop and implement effective business solutions through research, audit, and analysis of data and business processes. Key Responsibilities Audit and validate routine pre and post payment claims for compliance with policies and regulatory guidelines Perform routine and moderately complex audits on medical review claims to identify exceptions Research claims issues to determine origins and appropriate resolutions, summarizing findings in reports for management Required Qualifications High School Diploma or equivalent; some college coursework preferred Four years of general data management experience in claims processing or provider maintenance Knowledge of health insurance industry regulations and certification standards Experience with auditing provider data and claims processing systems Ability to maintain current knowledge of relevant products, policies, and procedures

Mar 3, 2025 - 23:40

A company is looking for a Senior Quality Auditor to develop and implement effective business solutions through research, audit, and analysis of data and business processes. Key Responsibilities Audit and validate routine pre and post payment claims for compliance with policies and regulatory guidelines Perform routine and moderately complex audits on medical review claims to identify exceptions Research claims issues to determine origins and appropriate resolutions, summarizing findings in reports for management Required Qualifications High School Diploma or equivalent; some college coursework preferred Four years of general data management experience in claims processing or provider maintenance Knowledge of health insurance industry regulations and certification standards Experience with auditing provider data and claims processing systems Ability to maintain current knowledge of relevant products, policies, and procedures