Claims Quality Auditor jobs in Los Angeles, CA

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)

Q
Claims Appeal Auditor
  • QUALITY CARE SURGERY CENTER, LLC
  • Northridge, CA FULL_TIME
  • Essential Duties and Responsibilities include the following:
     
    1.Maintain the workflow of all departmental projects.
     
    2.Ensure priority sorting, batching & logging by provider and provider type for all correspondence
     
    3.Provide reports and on-going updates to Claims management.
     
    4.Assist in the processing of appeals (reconsiderations), special projects and reconciliations from all sources.
     
    5.Oversees staff activities to maintain high level of productivity.
     
    6.Monitor appeals related functions to ensure health plan and regulatory compliance.
     
    7.Participate with training determined by Unit Senior Manager and Auditing Staff regarding Claims Adjudication education issues discovered in reconsideration reviews.
     
    8.Provide primary support to the Senior Manager of Appeals including special projects.
     
    9.Recommend process improvements based on appeal tracking and trending reports.
     
    10.Support Senior Manager in other company functions such as Medical Review management Health Plan audits.
     
    11.Handle and document resolution to escalated telephone and written appeals.
     
    12.Implement and coordinate issue resolution processes.
     
    13.Liaison for department with outside providers and internal departments.
     
    14.Provide supervisory coverage for Appeals unit as needed.
     
    15.Other duties as directed by management.
     

    The pay range for this position at commencement of employment is expected to be between $22.50-24.50/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

     

    The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

     

    Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

     

    If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

     

     

    As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

     

    Full Time Position Benefits:

    The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

    Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

     

    Health and Wellness:

    • Employer-paid comprehensive medical, pharmacy, and dental for employees
    • Vision insurance
    • Zero co-payments for employed physician office visits
    • Flexible Spending Account (FSA)
    • Employer-Paid Life Insurance
    • Employee Assistance Program (EAP)
    • Behavioral Health Services

    Savings and Retirement:

    • 401k Retirement Savings Plan
    • Income Protection Insurance

    Other Benefits:

    • Vacation Time
    • Company celebrations
    • Employee Assistance Program
    • Employee Referral Bonus
    • Tuition Reimbursement
    • License Renewal CEU Cost Reimbursement Program
    • Business-casual working environment
    • Sick days
    • Paid holidays
    • Mileage

     

    Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

     

     

  • 1 Month Ago

U
Claims Quality Auditor
  • UCLA Health Careers
  • Los Angeles, CA FULL_TIME
  • DescriptionTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the ne...
  • 15 Days Ago

U
Claims Quality Auditor
  • University of California - Los Angeles Health
  • Los Angeles, CA FULL_TIME
  • DescriptionTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the ne...
  • 1 Month Ago

R
Claims Auditor
  • REGAL MEDICAL GROUP, INC
  • West Covina, CA FULL_TIME
  • Position Summary: This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory ag...
  • Just Posted

I
Claims Auditor
  • Innovative Management Systems Incorporated
  • City of Industry, CA FULL_TIME
  • DescriptionTHE POSITION.This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to...
  • 6 Days Ago

T
Claims Auditor
  • TEKsystems
  • Northridge, CA FULL_TIME
  • Description: This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencie...
  • 14 Days Ago

Filters

Clear All

Filter Jobs By Location
  • Filter Jobs by companies
  • More

0 Claims Quality Auditor jobs found in Los Angeles, CA area

C
GRC Quality Assurance Lead
  • City National Bank
  • Los Angeles, CA
  • Overview: GRC QUALITY ASSURANCE LEAD WHAT IS THE OPPORTUNITY? The Quality Assurance function is a key role for the overa...
  • 4/24/2024 12:00:00 AM

O
Health & Safety Specialist
  • Opulent Solutions
  • Los Angeles, CA
  • Our client is hiring for: Health & Safety Specialist Summary The Health And Safety Specialist supports the implementatio...
  • 4/22/2024 12:00:00 AM

R
Quality Auditor
  • ResourceMFG
  • Simi Valley, CA
  • summary ResourceMFG is now hiring Quality Auditors in Lafayette! Pay and Hours: 1st Shift: 4am-12:30pm-$20/hr 2nd Shift:...
  • 4/22/2024 12:00:00 AM

S
Quality Auditor - Pharmaceutical - Senior
  • SQA Services
  • Los Angeles, CA
  • SQA is a leading Quality Assurance and Supply Chain solutions firm. SQA manages Supplier Audit and Supplier Development ...
  • 4/22/2024 12:00:00 AM

K
Quality Auditor
  • Kelly Science, Engineering, Technology & Telecom
  • Irvine, CA
  • Kelly Science and Clinical FSP is currently seeking a Quality Auditor for a 6 month contract in Irvine, CA with one of o...
  • 4/21/2024 12:00:00 AM

M
Customer Service Quality Auditor - Call Center *$1,000 Sign-On Bonus*
  • Missionheritage
  • Brea, CA
  • ** Customer Service Quality Auditor - Call Center *$1,000 Sign-On Bonus*** **** New **We are looking for Customer Servic...
  • 4/21/2024 12:00:00 AM

O
Health & Safety Specialist
  • Opulent Solutions
  • Los Angeles, CA
  • Our client is hiring for: Health & Safety Specialist Summary The Health And Safety Specialist supports the implementatio...
  • 4/21/2024 12:00:00 AM

D
Health & Safety Specialist, QHSE, Dangerous Goods
  • DSV Road Transport
  • Torrance, CA
  • DSV - Global transport and logistics In 1976, ten independent hauliers joined forces and founded DSV in Denmark. Since t...
  • 4/20/2024 12:00:00 AM

Los Angeles (/lɔːs ˈændʒələs/ (listen);[a] Spanish: Los Ángeles), officially the City of Los Angeles and often known by its initials L.A., is the most populous city in California, the second most populous city in the United States, after New York City, and the third most populous city in North America. With an estimated population of four million, Los Angeles is the cultural, financial, and commercial center of Southern California. The city is known for its Mediterranean climate, ethnic diversity, Hollywood and the entertainment industry, and its sprawling metropolis. Los Angeles is the larges...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Auditor jobs
$51,221 to $62,780
Los Angeles, California area prices
were up 3.2% from a year ago

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