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)
Job Summary: The Quality Auditor will be responsible for auditing departmental workflows and functions, ensuring the highest level of service is being delivered at all times. Provides feedback and support data related to quality of service and operational applications. Provides trends of errors and recommends process improvements to reduce or eliminate errors. Performs other duties as needed.
Education and Experience: High School Diploma or GED required. Bachelor's Degree preferred. Minimum two years of experience in a customer service environment required; preferably in Healthcare.
Knowledge and Skills: Able to keyboard 40 wpm. Able to read; write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
Licensures and Certifications: Valid Driver's License required at time of hire.
Clear All
0 Claims Quality Auditor jobs found in San Bernardino, CA area