Senior Health Claims Quality Auditor — Data-Driven Impact

Sutherland Global; Clifton (NJ); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Sutherland is seeking a Senior Quality Associate who will oversee performance and service quality to ensure customer satisfaction. You will analyze claims data, identify trends, and report findings to management while supporting client relationships.

You should have 2–3 years in medical claims processing or healthcare auditing, strong analytical and communication skills, and proficiency with MS Office. Experience with CMS-1500/UB-04 and Medicare/Medicaid regulations is a plus.

Qualifications

• Understanding of standard claim forms such as CMS-1500 and UB-04.
• 2–3 years direct experience in medical claims processing, medical billing, or healthcare auditing.
• Spot minor billing errors, discrepancies, or potential fraud.
• Strong written and verbal communication to report audit findings clearly.
• Expert knowledge of complex commercial payer contracts, reimbursement methodologies, and Medicare/Medicaid regulations.
• Experience with process documentation.
• Ability to work in MS Office.
• Ability to work in a fast-paced environment.
• Pro-active in developing trust and professional rapport with employees and team members; team-player.
• Strong analytical skills; be able to interpret data, identify trends, and make suggestions for improvements.

Responsibilities

• Define Sutherland’s reputation by overseeing performance and service quality to guarantee customer satisfaction.
• Establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations.
• Relay important information in timely and accurate reports to management.
• Produce solid, data-driven strategies based on reports and observations to impact the bottom line.
• Experience in US Healthcare; knowledge in handling claims process (Commercial and/or Medicaid); handle high-dollar claims.

Skills

Analytical skills

Strong communication

Team player

Attention to detail

Tools

MS Office

Job description

Sutherland is seeking a Senior Quality Associate who will oversee performance and service quality to ensure customer satisfaction. You will analyze claims data, identify trends, and report findings to management while supporting client relationships.

You should have 2–3 years in medical claims processing or healthcare auditing, strong analytical and communication skills, and proficiency with MS Office. Experience with CMS-1500/UB-04 and Medicare/Medicaid regulations is a plus.