Remote Claims Quality Auditor for Health Plans

HealthEdge Software, Inc.; Northern (KY); Hybrid; USD 44,000 - 50,000; Full time

Job summary

HealthEdge Software, Inc. is seeking a Claims Quality Auditor to perform audits of health plan transactions, including claims, enrollment, and premium billing, with oversight from the Lead Auditor or Quality Audit Manager.

The role supports improvements by identifying errors and opportunities for optimization in a remote, US-based environment. Candidates need a high school diploma or GED and at least 3 years of health plan claims auditing experience; Medicaid auditing experience is a plus.

Qualifications

• 3 years health plan claims auditing operations experience required.
• High School Diploma or GED required.
• Proficiency in MS Office (Excel, PowerPoint, Outlook)
• HealthRules Payor or Guiding Care experience preferred.
• Ability to analyze contractual SLAs and KPIs (remote team)

Responsibilities

• Audit transactions processed by health plan administration associates for a specific customer.
• Follow customer quality process and tools for audit and rebuttal processes.
• Share QA results with associates and provide feedback to improve accuracy.
• Collate and report QA performance to management and individuals.
• Provide inputs to Training team for updates to processing instructions.

Skills

Attention to detail

Effective communication

Remote collaboration

Education

High School Diploma or GED

Tools

MS Suite

Excel

PowerPoint

Outlook

Job description

HealthEdge Software, Inc. is seeking a Claims Quality Auditor to perform audits of health plan transactions, including claims, enrollment, and premium billing, with oversight from the Lead Auditor or Quality Audit Manager.

The role supports improvements by identifying errors and opportunities for optimization in a remote, US-based environment. Candidates need a high school diploma or GED and at least 3 years of health plan claims auditing experience; Medicaid auditing experience is a plus.