Remote Medical Claims Auditor I – Quality Assurance

Moda Health; Portland (OR); A distancia; USD 25.000 - 28.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, Dental, Vision, Pharmacy,Life

401K- Matching

FSA

EAP

PTO and Holidays

Descripción de la vacante

Moda Health is seeking a detail-oriented QA auditor to ensure correct adjudication and application of post-payment claims. The role supports remote operations, requiring strong analytical and communication skills.

You will generate reports and help improve accuracy and efficiency across claim processes. The ideal candidate has experience with claims processing systems and can manage multiple tasks under deadlines while maintaining confidentiality.

Formación

• High school diploma or equivalent.
• 6 months–2 years claim processing or customer service dealing with all types of plans/claims.
• Strong reading, writing, and verbal communication skills.
• Good analytical, problem solving, organizational and detail-oriented skills.
• 10-key proficiency on a computer numeric keypad.
• Type a minimum of 25 wpm net on a numeric keyboard.
• Ability to maintain confidentiality and project a professional business image.

Responsabilidades

• Audit claims daily using prescriber audit criteria and perform simple adjustments as needed.
• Conduct in-depth audits on performance groups and focused audits on identified situations.
• Compile and publish weekly, monthly, and quarterly audit reports and processor productivity.
• Run PBIRS reports to conduct audits and ensure accuracy.
• Prepare monthly/quarterly reports for group performance guarantees and results.
• Identify trends from audits and recommend improvements to raise overall quality.
• Assist in investigations and respond to inquiries from performance groups.
• Other duties as assigned.

Conocimientos

Reading & writing

Verbal communication

10-key data entry

Typing 25 wpm

Claims processing systems

Microsoft Office

Confidentiality

Educación

High school diploma

Herramientas

Facets

Benefit Tracker

Employer Online Services

PBIRS

Descripción del empleo

Moda Health is seeking a detail-oriented QA auditor to ensure correct adjudication and application of post-payment claims. The role supports remote operations, requiring strong analytical and communication skills.

You will generate reports and help improve accuracy and efficiency across claim processes. The ideal candidate has experience with claims processing systems and can manage multiple tasks under deadlines while maintaining confidentiality.