Claims Quality Auditor jobs in Oakland, CA

Your Role

The Quality Assurance Team conducts audits, documents quality issues and performance measures and conducts review of policies and procedures to ensure alignment with service level requirements.   The Quality Assurance Auditor, Advanced will report to the Quality Assurance Manager. In this role they will conduct quality reviews on multiple lines of business and identify and document audit observations and findings.

Your Work

In this role, you will:

• Be responsible for performing audits that are routine in nature where limited judgment is required
• Focus on multiple areas of expertise or line of business (Claims, Inquiry, Enrollment); objectively review and interpret standards, procedural documentation and contract and legal verbiage
• Identify and document audit observations and findings
• Notify Supervisor when communications with operations are necessary; coordinate appropriate messaging 
• Identify and resolve routine problems independently; escalate issues with Supervisor as appropriate
• Manage timelines, assignments, and work plans.