Hybrid Membership Quality Auditor (Enrollment & Billing)

Moda Health; Portland (OR); Hybrid; USD 49,000 - 55,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy,Life

401K Matching

FSA

Employee Assistance Program

PTO and Holidays

Job summary

Moda Health seeks a Quality Assurance Auditor in Portland, Oregon for a full‑time hybrid role. You will audit enrollments, billing and reconciliation daily using statistically valid sampling, report on quality trends, and ensure adherence to all applicable regulations and standards.

The ideal candidate has 1–2 years of quality review experience in a health insurance environment, strong communication and analytical skills, and proficiency with Word and Excel.

Qualifications

• High School diploma or equivalent required.
• 1–2 years quality review experience in health insurance environment preferred.
• Strong interpersonal, effective and diplomatic communication.
• Proficiency with Word, Excel and web-based tools.
• Excellent reading, verbal and written communication.

Responsibilities

• Audit enrollments, billings and reconciliation daily using sampling.
• Ensure QA standards and compliance with state and federal regulations.
• Conduct in-depth enrollment, billing and reconciliation audits.
• Prepare monthly/quarterly performance reports.
• Identify trends and recommend quality improvements.
• Create and update documentation and procedures.
• Support quality initiatives and teamwork.
• Other duties as assigned.

Skills

Interpersonal skills

Communication skills

Detail-oriented

Analytical thinking

Team player

Education

High School diploma

Tools

Microsoft Word

Microsoft Excel

Job description

Moda Health seeks a Quality Assurance Auditor in Portland, Oregon for a full‑time hybrid role. You will audit enrollments, billing and reconciliation daily using statistically valid sampling, report on quality trends, and ensure adherence to all applicable regulations and standards.

The ideal candidate has 1–2 years of quality review experience in a health insurance environment, strong communication and analytical skills, and proficiency with Word and Excel.