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Claims QA Auditor - Remote

Posted 2 weeks ago
QA
Full Time
USA

Overview

The Claims QA Auditor is primarily responsible for pre-payment, post-payment, and adjudication audits of claims across multiple employer groups and products, ensuring accuracy and compliance with processing standards.

In Short

  • Perform auditing of claims for accuracy and compliance.
  • Complete reporting of audits for quality reporting and analysis.
  • Communicate corrections and adjustments to claims examiners.
  • Identify and escalate trends based on quality reviews.
  • Confer with team leads and managers on quality issues.
  • Investigate issues to improve standard processing guidelines.
  • Participate in projects as a subject matter expert.
  • Assist in training and mentoring examiners.

Requirements

  • Experience with automated claims processing systems.
  • Knowledge of processing principles and techniques.
  • Strong analytical and organizational skills.
  • Attention to detail and quality-driven mindset.
  • High School diploma or GED required.
  • Minimum of three years of experience in claims auditing.
  • Proficient in MS Word, Excel, Outlook, and PowerPoint.

Benefits

  • Opportunity to work in a mission-driven company.
  • Potential for remote work options.
  • Supportive team environment.
  • Professional development opportunities.

Centivo

Centivo

Centivo is an innovative health plan designed for self-funded employers, dedicated to providing affordable, high-quality healthcare to millions facing financial challenges with their medical bills. Utilizing a primary care-based ACO model, Centivo offers significant savings—15 to 30 percent—compared to traditional insurance carriers, while also delivering substantial benefits to employees, including free primary care and a no-deductible plan design. The company serves a diverse range of employers, from small businesses to Fortune 500 companies, and is headquartered in Buffalo, NY, with additional offices in New York City. Centivo is supported by prominent healthcare and technology investors, including Morgan Health, a unit of JPMorgan Chase & Co.

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