Healthcare Quality Auditor, PHRN – Onsite & Reporting

Carelon Global Solutions; Taguig; On-site; PHP 300,000 - 540,000; Full time

Job summary

Carelon Global Solutions is seeking a Quality Auditor to evaluate the quality of services and interactions across enrollment, billing, claims processing, and customer service. You will audit transactions, identify issues, report findings, and generate periodic reports for management.

Requirements include a BA/BS degree, 3 years in quality audit with 1+ year in healthcare or insurance, and a 100% onsite work arrangement. Knowledge of ICD-10 and medical terminology is essential.

Qualifications

• Requires BA/BS degree; 3 years of experience including at least 1 year in a Quality Audit role.
• Active PHRN license required.
• Strong knowledge of ICD-10 coding standards and healthcare terminology.
• Experience in healthcare, insurance, claims processing, enrollment, billing, and customer service operations.

Responsibilities

• Evaluates quality and accuracy of transactions and communications with providers, groups, and policyholders.
• Documents and reports errors and issues to ensure prompt resolution.
• Tracks audit results and provides feedback to management; generates monthly audit reports.

Skills

Quality audit

Medical coding

Chart review

ICD-10

Healthcare terminology

Audit reporting

Education

BA/BS degree

PHRN license

Job description

Carelon Global Solutions is seeking a Quality Auditor to evaluate the quality of services and interactions across enrollment, billing, claims processing, and customer service. You will audit transactions, identify issues, report findings, and generate periodic reports for management.

Requirements include a BA/BS degree, 3 years in quality audit with 1+ year in healthcare or insurance, and a 100% onsite work arrangement. Knowledge of ICD-10 and medical terminology is essential.