Healthcare Quality Auditor | Provider Services

Imagenet Phils., Inc.; Makati; On-site; PHP 400,000 - 700,000; Full time

Benefits offered by this job

HMO Coverage

Day-1 HMO for dependents

Job summary

Imagenet Phils., Inc. is seeking a Healthcare Quality Auditor for Provider Services in Metro Manila. You will review provider interactions, claims-related work, and documentation to ensure accuracy, compliance, and high provider experience.

You will apply QA scorecards, audit forms, and SOPs, identify gaps, and provide clear feedback to Advocates and operations partners. The role requires 4–5 years in healthcare QA and the ability to work flexible hours.

Qualifications

• At least 4–5 years in healthcare contact center, provider services, or QA role.
• 2–3 years as Quality Auditor/QA-Analyst/SME.
• Strong knowledge of claims, EOBs, eligibility, benefits, and payments.
• Ability to interpret QA guidelines and justify audit findings.
• Excellent written and verbal communication.
• Ability to work nights, weekends, holidays as needed.
• Proficiency with multiple systems and software.

Responsibilities

• Perform QA audits of provider-service interactions and documentation.
• Meet audit volume, sampling, and turnaround targets.
• Review data accuracy, policy accuracy, and compliance.
• Provide actionable audit feedback to staff and leaders.
• Maintain audit records in QA platforms.
• Identify recurring errors and escalation needs.

Skills

Analytical thinking

Problem-solving

Decision-making

Organizational skills

Verbal communication

Written communication

Attention to detail

Customer service excellence

Flexibility with schedules

Education

High school diploma or equivalent

College degree preferred

Healthcare or QA-related coursework

Tools

Microsoft Office

Monday.com

AWS Connect

QA platforms

Call recording tools

Claims systems

Workforce management tools

Performance dashboards

Job description

About the role

The Healthcare Quality Auditor - Provider Services is responsible for reviewing, evaluating, and scoring healthcare provider-service interactions and related documentation to ensure accuracy, compliance, process adherence, and consistent provider experience. This role supports quality assurance across inquiries related to eligibility, claims, payments, appeals, Explanation of Benefits (EOBs), provider dispute resolution, and other provider-facing workflows.

Key responsibilities

• Complete assigned quality audits for provider-service interactions, claims-related transactions, documentation, and other designated work types within established audit volume, sampling, quality, and turnaround-time requirements

• Complete actual production work, including taking calls when assigned, and achieving the required production volume and cadence expectations

• Apply approved QA scorecards, audit forms, client requirements, standard operating procedures, and scoring guidelines consistently and objectively

• Review work for data accuracy, policy accuracy, financial or claims-impact accuracy, documentation quality, compliance adherence, call-handling standards, and timely resolution

• Audit provider-service inquiries across applicable channels, including phone, email, fax, web inquiries, and other designated communication channels

• Validate that Advocates use approved resources, follow proper workflows, document interactions completely, and provide accurate provider-facing information

• Identify critical errors, repeat errors, compliance risks, documentation gaps, process misses, and provider-experience concerns requiring immediate escalation

• Maintain accurate audit records and ensure all audit results are entered, stored, and reported in the designated QA platform or reporting tracker

• Provide timely, clear, specific, and constructive audit feedback to Advocates, Team Leaders, and Operations partners in accordance with established timelines

• Identify, document, and trend recurring and preventable errors across individual, team, process, training, system, and compliance categories

About you

• High school diploma or equivalent required; college degree or relevant post-secondary education is preferred

• At least 4 to 5 years of experience in a healthcare contact center, provider services, claims support, claims processing, quality assurance, or comparable healthcare operations environment

• Prior experience of 2-3 years as a Quality Auditor, QA-Analyst, or SME

• Working knowledge of healthcare claims, EOBs, appeals, eligibility, benefits, payment processes, provider-service workflows, documentation standards, and contact-center operations

• Demonstrated ability to interpret QA guidelines, identify errors, apply scoring criteria consistently, and provide clear rationale for audit findings

• Strong analytical, problem-solving, decision-making, organizational, verbal, and written communication skills

• Exceptional attention to detail and demonstrated commitment to quality, accuracy, compliance, confidentiality, and customer/provider experience

• Ability to work flexible schedules, including nights, weekends, and holidays, based on client coverage and quality requirements

• Proficiency with Microsoft Office and online systems; ability to learn and navigate multiple healthcare, client, QA, reporting, workforce, and performance-management systems

• Experience with Monday.com, AWS Connect, QA platforms, call-recording tools, claims systems, workforce tools, and performance dashboards is highly preferred

Benefits

• Comprehensive HMO Coverage - Medical & Dental

• HMO coverage on Day 1 plus 1 dependent

About us

Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients. Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve. Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines.