Claims Quality Auditor

This is a Fully Remote Job 1. About Our Client:The organization operates in the health insurance technology and services sector, focusing on providing infrastructure and solutions that enhance the efficiency and competitiveness of health plans. It supports health plan operations by delivering integrated ecosystems designed to promote affordable and equitable healthcare. The organization has a significant global presence with a workforce exceeding 4,000 employees and emphasizes simplicity, integrity, people-centricity, and leadership in its operations. 2. About the Opportunity:The Claims Quality Auditor role is responsible for auditing health plan claims and related transactions to ensure accuracy and compliance with quality standards. This position plays a key role in identifying errors and opportunities for improvement in claims processing, contributing to operational quality and customer satisfaction. The role involves close collaboration with audit teams and operational managers and supports training and quality improvement initiatives. 3. Responsibilities:Audit transactions processed by health plan administration associates for specified customers.Follow established quality processes and tools for audits and rebuttals.Share audit results with associates and coordinate feedback with team leads and managers.Compile and report quality audit performance for individuals and teams to management.Provide input to training teams and team leads on processing instructions and refresher training needs.Participate in audit calibration and "Audit the Auditor" programs.Maintain current knowledge of CMS claims processing rules and guidelines for Medicare Advantage and ACA Exchange lines of business. 4. Requirements:High School Diploma or GED.Minimum of 3 years experience in health plan claims auditing operations.Medicaid claims auditing experience preferred.Proficiency in Microsoft Excel, PowerPoint, and Outlook.Experience with HealthRules Payor or Guiding Care preferred.Ability to analyze contractual SLAs and KPIs.Effective communication and collaboration skills in a remote team environment. 5. Pay Range and Compensation Package:The annual US base salary range for this position is $44,000 to $50,000. This salary range may cover multiple career levels within the organization. Final compensation will be determined during the interview process based on skills, experience, qualifications, and education. Equal Opportunity Statement:Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.