Sr. Associate - Health Claims Quality Auditor

Sutherland; Clifton (NJ); On-site; USD 65,000 - 90,000; Full time

Job summary

Sutherland in the United States is seeking a Sr. Associate - Health Claims Quality Auditor to uphold performance and service quality, ensuring customer satisfaction.

This role requires 2–3 years in medical claims processing or healthcare auditing, knowledge of CMS-1500/UB-04, and strong analytical and communication skills to report audit findings and drive process improvements.

Qualifications

• Minimum of 2 to 3 years of direct experience in medical claims processing, medical billing, or healthcare auditing.
• Ability to spot minor billing errors, discrepancies, or potential fraud.
• Expert knowledge of complex commercial payer contracts, reimbursement methodologies, and federal Medicare/Medicaid regulations.
• Experience with process documentation.
• Strong written and verbal communication skills to report audit findings clearly.
• 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; work as a team-player.
• Have strong analytical skills; be able to interpret data, identify trends, and make suggestions for improvements.

Responsibilities

• Define Sutherland’s reputation by overseeing and managing performance and service quality to guarantee customer satisfaction.
• Strengthen relationships: establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations.
• Keep management updated: relay important information in the form of timely and accurate reports.
• Impact the bottom line: produce solid and effective strategies based on accurate and meaningful data reports and analysis and/or keen observations.

Skills

Claims processing

Healthcare auditing

CMS-1500 / UB-04

Analytical skills

MS Office

Communication

Fraud detection

Job description

Sr. Associate - Health Claims Quality Auditor

Full-time

At Sutherland, we are committed in creating a dynamic work environment that is professionally challenging and personally rewarding. Our team is composed of goal-oriented and strategic-thinking individuals and we are looking to add as an Operations Manager who will establish and create strategies that will enhance processes and boost ease and efficiency. As an Operations Manager, you will set the path to success by managing performance and service quality to guarantee customer satisfaction.

Job Description:

Our Senior Quality Associates get to: Define Sutherland’s reputation: Oversee and manage performance and service quality to guarantee customer satisfaction Strengthen relationships: Establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations Keep management updated: Relay important information in the form of timely and accurate reports Impact the bottom line: Produce solid and effective strategies based on accurate and meaningful data reports and analysis and/or keen observations. Experience in US Healthcare, Knowledge in handling claims process. (Commercial and/or Medicaid). Should have extensive experience in handling high dollar claims.

Requirements:

• Understanding of standard claim forms such as CMS-1500 and UB-04.
• Minimum of 2 to 3 years of direct experience in medical claims processing, medical billing, or healthcare auditing.
• Ability to spot minor billing errors, discrepancies, or potential fraud
• Strong written and verbal communication skills to report audit findings clearly
• Expert knowledge of complex commercial payer contracts, reimbursement methodologies, and federal 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; work as a team-player
• Have strong analytical skills; be able to interpret data, identify trends, and make suggestions for improvements

All your information will be kept confidential according to EEO guidelines.

EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

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