Claims QA Auditor

The Claims QA Auditor plays a crucial role in maintaining the integrity of the claims process by performing detailed audits of claims. This includes ensuring processing, payment, and financial accuracy by verifying all aspects of the claim against standard processes and client's plan descriptions. The role involves completing reports with decision methodology to identify procedural and monetary errors, which are used for quality reporting and trending analysis. The auditor communicates corrections to examiners, escalates identified trends, and collaborates with supervisors and the training lead to address problematic issues. Additionally, the role may encompass investigating and researching issues to improve processing guidelines and participating in projects as a subject matter expert, working under limited supervision while providing coaching to others.