Claims Quality Auditor jobs in the United States

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.

     

     

  • 9 Days Ago

V
Auditor
  • VERUS CLAIMS SERVICES LLC
  • Princeton, NJ FULL_TIME
  • DescriptionSUMMARYThe Claims Auditor is responsible for testing and evaluating the audits, ensuring compliance with pre-established Procedures, Agreements, and Audit Protocol. In addition, the Claims ...
  • 2 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...
  • 18 Days Ago

A
Operations Quality Auditor- Claims
  • AmeriHealth Caritas Health Plan
  • Philadelphia, PA FULL_TIME
  • Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities....
  • Just Posted

A
Operations Quality Auditor- Claims
  • AmeriHealth Caritas Health Plan
  • Jacksonville, FL FULL_TIME
  • Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities....
  • Just Posted

U
Claims Quality Auditor
  • UCare
  • Minneapolis, MN FULL_TIME
  • Active - Regular full-time | #169 | 2 days ago Minneapolis, Minnesota Job Description ABOUT UCARE UCare offers Medicare, Medicaid, Individual and Family health plans – powered by the hardest working p...
  • 1 Day Ago

L
Quality Assurance Specialist III
  • LGC Group
  • Gaithersburg, MD
  • Company Description LGC Clinical Diagnostics Business Unit is comprised of our operating entities including LGC Clinical...
  • 3/28/2024 12:00:00 AM

K
Quality Assurance Manager (REMOTE)
  • Koniag Government Services
  • Chantilly, VA
  • Kadiak Job ID 24200057 Kadiak, LLC, a Koniag Government Services company, is seeking a Quality Assurance Manager with a ...
  • 3/28/2024 12:00:00 AM

G
Corporate Quality Management Lead
  • GAMA-1 Technologies
  • Chevy Chase, MD
  • Job Description Job Description GAMA-1 Technologies, LLC is seeking a highly qualified and experienced remote Corporate ...
  • 3/28/2024 12:00:00 AM

L
Quality Assurance Analyst
  • Leidos
  • Silver Spring, MD
  • Description Leidos has an opening for a Quality Assurance Analyst to support our National Oceanic and Atmospheric Admini...
  • 3/27/2024 12:00:00 AM

N
Assistant Inspector General for Inspections and Evaluations
  • National Geospatial-Intelligence Agency
  • Springfield, VA
  • Summary The AIG Inspection is responsible for developing strategies for achieving both mandatory and elective inspection...
  • 3/25/2024 12:00:00 AM

L
Quality Assurance Manager
  • Leidos
  • Bethesda, MD
  • Description The National Security Sector of Leidos has a career opportunity for a talented Quality Assurance Manager for...
  • 3/19/2024 12:00:00 AM

L
Quality Assurance Manager
  • Leidos
  • Chantilly, VA
  • Description The National Security Sector of Leidos has a career opportunity for a talented Quality Assurance Manager to ...
  • 3/19/2024 12:00:00 AM

L
Quality Assurance Manager
  • Leidos
  • McLean, VA
  • Description The National Security Sector of Leidos has a career opportunity for a talented Quality Assurance Manager for...
  • 3/19/2024 12:00:00 AM

Income Estimation for Claims Quality Auditor jobs
$45,858 to $56,210