Claims Quality Auditor jobs in Atlanta, GA

Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

A
Claims Auditor
  • AssuranceAmerica
  • Atlanta, GA FULL_TIME
  •  

    Job Summary:

    This position is responsible for the oversight of complex and large exposure losses and will report to the National Casualty & Audit Manager. This position will not only participate both general and targeted audits but will also review audits performed by claims management, ensuring that compliance with best practices is achieved. In addition, this position will report findings and make recommendations on current practices including the claim department’s performance on meeting regulatory standards.

     

    Job Responsibilities:

     

    · Responsible for providing guidance and direction to claims staff in order to ensure proper handling and risk mitigation.

    · Responsible for collaboration with claims staff, front line claims management, senior claims management and legal counsel.

    · Available to answer questions and participate in roundtable discussions with claims staff and management to provide feedback and guidance on claim handling procedures.

    · Complete research pertaining to complex coverage issues, industry trends, and related topics.

    · Responsible for independent audits of each functional area within claims to ensure that handling is within best practice guidelines.

    · Perform targeted audits, which may include a particular process or function (e.g. total loss handling, BI evaluations, cycle times, regulatory reviews, customer service skills, etc.).

    · Review managers’ completed audits to verify calibration and accuracy of the first level reviews completed.

     

    Qualifications:

    Required

    · A minimum of five (5) years adjusting claims including at least two (2) years adjusting claims with high complexity.

    · Bachelor’s Degree.

     

    Preferred

    · Prior Claims Management Experience.

    Core Competencies:

    · Must be able to work in a fast-paced automated production environment.

    · Must employ excellent communication/interpersonal and customer service skills.

    · Leadership abilities are necessary, with the ability to make autonomous decisions based on multiple facts.

    · Demonstrated team building and coordination skills.

    · Demonstrated ability to partner with management to identify and address operations, customer service, and underwriting issues.

    · Solid planning and organizational skills including time management, prioritization, and attention to detail.

    · Demonstrated ability to accomplish goals through influence management.

    · Direct, results driven, and dedicated to the success of the business and each other.


    Qualifications:

     

    Required

    ·       A minimum of five (5) years adjusting claims including at least two (2) years adjusting claims with high complexity.

    ·       Bachelor’s Degree.

     

    Preferred

    ·       Prior Claims Management Experience.

     

    Core Competencies:

     

    ·       Must be able to work in a fast-paced automated production environment.

    ·       Must employ excellent communication/interpersonal and customer service skills.

    ·       Leadership abilities are necessary, with the ability to make autonomous decisions based on multiple facts.

    ·       Demonstrated team building and coordination skills.

    ·       Demonstrated ability to partner with management to identify and address operations, customer service, and underwriting issues.

    ·       Solid planning and organizational skills including time management, prioritization, and attention to detail.

    ·       Demonstrated ability to accomplish goals through influence management.

    ·       Direct, results driven, and dedicated to the success of the business and each other.



  • 12 Days Ago

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Quality Auditor
  • Primex Plastics Corp
  • Oakwood, GA FULL_TIME
  • Primex Plastics Corporation, an international leader in the extruded plastic industry, is currently seeking a Quality Auditor for 3rd shift. Primex and its Subsidiaries provide custom plastic sheet ex...
  • 24 Days Ago

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Quality System Auditor & Waste Auditor
  • Bridgestone Americas
  • Covington, GA FULL_TIME
  • ESSENTIAL DUTIES AND RESPONSIBILITIES Perform routine daily checks of the quality control data and each layer’s approval at each production process.Perform routine daily checks of the waste record and...
  • Just Posted

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Warehouse Quality Auditor
  • Ryder
  • COLLEGE PARK, GA FULL_TIME
  • Position Description Ryder is immediately hiring a Permanent Full Time Warehouse Quality Auditor in College Park, GA Warehouse Positions Pay Weekly Hourly Pay $19.50 per hour Additional Pay: $0.50 per...
  • 1 Month Ago

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Claims Quality Assurance and Compliance Specialist
  • Westfield
  • Alpharetta, GA FULL_TIME
  • We are seeking a detail-oriented and analytical individual to join our team as a Specialty Claims Quality Assurance and Compliance Specialist. This role will report to the VP, Specialty Claims Complia...
  • 19 Days Ago

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Claims Quality Assurance and Compliance Specialist
  • Ohio Farmers Insurance Company
  • Alpharetta, GA FULL_TIME
  • We are seeking a detail-oriented and analytical individual to join our team as a Specialty Claims Quality Assurance and Compliance Specialist. This role will report to the VP, Specialty Claims Complia...
  • 14 Days Ago

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0 Claims Quality Auditor jobs found in Atlanta, GA area

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Professional Coding Quality Auditor
  • Children's Healthcare of Atlanta
  • Atlanta, GA
  • Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your ...
  • 3/28/2024 12:00:00 AM

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Deputy Quality Assurance Manager
  • Tetra Tech, Inc.
  • Atlanta, GA
  • Tetra Tech is looking for a Deputy Quality Control Manager (remote/hybrid) that supports the Operating Unit (OU) Quality...
  • 3/28/2024 12:00:00 AM

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Inpatient Coding Quality Auditor
  • Children's Healthcare of Atlanta
  • Atlanta, GA
  • Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your ...
  • 3/25/2024 12:00:00 AM

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Outpatient Coding Quality Auditor
  • Children's Healthcare of Atlanta
  • Atlanta, GA
  • Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your ...
  • 3/25/2024 12:00:00 AM

T
FSQR Auditor
  • The Judge Group
  • Atlanta, GA
  • FSQR Auditor Direct Hire Position is outside of the Atlanta, GA AreaPay is dependent on ExperienceRequired Experience/Sk...
  • 3/25/2024 12:00:00 AM

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Coding Auditor & Educator
  • United Musculoskeletal Partners, LLC
  • Atlanta, GA
  • Job Type Full-time Description The Coding Quality Auditor and Educator conducts risk-based coding quality audits of prov...
  • 3/25/2024 12:00:00 AM

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HOOTS - Shift Supervisor
  • Hooters
  • Atlanta, GA
  • Hoots Restaurants offer fast casual dining with a limited, moderately-priced menu that features chicken wings, seafood, ...
  • 3/25/2024 12:00:00 AM

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Quality Manager
  • Woodbridge
  • Lithonia, GA
  • Legal Entity: Woodbridge Corporation Requisition ID: 2776 Woodbridge is a privately-owned company offering innovative ma...
  • 3/24/2024 12:00:00 AM

Atlanta (/ætˈlæntə/) is the capital of, and the most populous city in, the U.S. state of Georgia. With an estimated 2017 population of 486,290, it is also the 38th most-populous city in the United States. The city serves as the cultural and economic center of the Atlanta metropolitan area, home to 5.8 million people and the ninth-largest metropolitan area in the nation. Atlanta is the seat of Fulton County, the most populous county in Georgia. A small portion of the city extends eastward into neighboring DeKalb County. Atlanta was originally founded as the terminating stop of a major state-sp...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Auditor jobs
$45,042 to $55,209
Atlanta, Georgia area prices
were up 1.4% from a year ago

Claims Quality Auditor in Bloomington, IN
Evaluates claims activities of other departments and / or companies.
December 05, 2019