Quality Auditor l

Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.

*This position is located Remote Anywhere US*

Position Purpose:

Performs complex (journey-level) quality audit work.  Audits second level appeals of claims to ensure compliance with contract requirements and performs user testing and interface with the required systems.   Works under general supervision, with moderate latitude for the use of initiative and independent judgement. 

Essential Responsibilities:

• Performs audits and examinations of case files to identify inaccuracies and non-compliance issues.
• Shares educational feedback, trends and insight individually and collectively with the staff.
• Performs data analysis to identify improvement opportunities in the appeals process and reduce unnecessary appeals.
• Provides quality and analytical support to the department including assisting senior analyst in data interpretation and preliminary analysis.
• Prepares training materials and provides technical training to employees.

Minimum Qualifications

Education

• High School Diploma or equivalent

Experience

• Three (3) years of general office experience

• College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)

• One (1) year of dispute resolution experience or other healthcare appeals processes
• Quality, preferred
• Dispute resolution experience, preferred

Benefits

C2C offers an excellent benefits package, including:

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

EOE Vet/Disability