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
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