[Hiring] Healthcare Claims Quality Auditor @TekCommands

Role Description

We are seeking experienced Healthcare Claims Quality Auditors to support the Claims Quality Improvement (CQI) program. The role will perform end-to-end audits of processed healthcare claims, identify payment and processing errors, document audit findings, and support quality improvement initiatives.

The CQI program includes random, targeted, and analytics-driven audits across Amisys, including End-to-End, PFP, Business Partner, and High Dollar claims.

Job Responsibilities:

• Perform end-to-end audits of healthcare claims for processing and payment accuracy.
• Identify errors related to eligibility, benefits, provider information, pricing, coding, denials, adjustments, and supporting documentation.
• Conduct random and targeted audits and accurately document findings.
• Identify recurring error trends and support root-cause and quality-improvement activities.
• Meet established productivity, quality, and accuracy expectations.
• Participate in calibration, training, and process-improvement sessions.

Qualifications

• 3+ years of healthcare claims processing, adjudication, audit, or quality experience.
• Strong understanding of the end-to-end healthcare claims lifecycle.
• Experience reviewing claims for processing and payment accuracy.
• Strong analytical, problem-solving, and attention-to-detail skills.
• Ability to interpret SOPs, business rules, policies, and claim documentation.
• Strong written and verbal communication skills.

Requirements

• 1+ year of Claims Audit / QA experience.
• Experience with Amisys.
• Experience with Medicaid, Medicare, or Marketplace claims.
• Experience with High Dollar and end-to-end claims auditing.
• Experience with root-cause analysis and quality/error trend identification.

Company Description

TekCommands, Inc

24155 Drake Rd., Suite 130, Farmington Hills, MI 48335

Direct: 248-247-5532 | Fax: 248-743-1802

Email: [email protected] | Website: www.tekcommands.com