[Hiring] Claims Quality Auditor @HealthEdge

Role Description

UST HealthProof is looking for a Claims Quality Auditor with health plan claims administration operations experience. This role will report to the Lead Auditor or Quality Audit Manager. The Quality Auditor performs audits of an assigned group of transactions (claims, enrollment, premium billing, paper claims and correspondence scanning) and will interact with the client audit team and operational managers daily to report on audit findings, which have an impact on production and quality. This role requires the ability to work both independently with limited supervision and collaboratively in a team environment.

• Perform audit of transactions processed by health plan administration associates for a specific customer.
• Be responsible for following the customer quality process and tools for audit and rebuttal process.
• Share QA results with individual associates, coordinate with operational Team Leads and managers to provide feedback to individuals, clearly identifying errors and opportunities for improvement.
• Collate, compile and report both team and individual associates’ QA performance to management and individuals.
• Provide inputs to Training team and Team Leads for up-to-date written processing instruction/refresher training needs.
• Participate in UST HealthProof’s or the customers’ Audit the Auditor program.
• Participate in semi-annual or annual auditor calibration activities.
• Maintain currency on CMS claims processing rules and guidelines for Medicare Advantage organizations and ACA Exchange and Off Exchange lines of business.

Qualifications

• High School Diploma or GED required.
• 3 years health plan claims auditing operations experience required.
• Medicaid claims auditing experience preferred.
• Proficiency in using MS Suite, specifically Excel, PowerPoint and Outlook.
• HealthRules Payor or Guiding Care experience preferred.
• Ability to analyze contractual SLAs and KPIs.
• Ability to effectively communicate and collaborate with a remote team.

Requirements

• Remote, US.
• Full-time, permanent.
• The employee is occasionally required to move around the office.
• Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

Benefits

• The annual US base salary range for this position is $44,000 to $50,000.
• This salary range may cover multiple career levels at HealthEdge.
• Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications, and education.

Company Description

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology.

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations that helps our customers achieve affordable, equitable health care for all. We have a strong global presence, with a workforce of over 4,000 people built on a foundation of simplicity, integrity, people-centricity, and leadership.