Senior Quality Auditor

Centene Corporation

Senior Quality Auditor improving Centene healthcare claims accuracy and compliance. Auditing claims and provider data while reporting findings to strengthen healthcare operations.

Posted 9/1/2026full-timeRemote • Montana • 🇺🇸 United StatesSenior💰 $23 - $40 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing and validating claims, managing provider data, and ensuring compliance with health insurance regulations. Proficient in analyzing discrepancies and summarizing findings to enhance claims processing and quality improvement.

Highest-signal resume keywords

Claims ProcessingData ManagementAudit and ValidationHealth Insurance RegulationsProvider Data Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ResearchData AnalysisAudit ProceduresCompliance StandardsContract CodingBenefit Plan CodingQuality ImprovementStatistical ReportingDiscrepancy ResolutionHealth Net Products Knowledge

Soft Skills

CommunicationProblem-SolvingAttention to Detail

Industry Keywords

Health InsuranceClaims AdjudicationProvider MaintenanceRegulatory AgenciesCertification Bodies

About the role

Key responsibilities & impact

Develop and implement effective business solutions through research, audit, and data and/or business-process analysis
Audit and validate routine pre- and post-payment claims for correct adjudication and compliance
Audit provider data loaded into claims processing systems
Document and report audit results
Research claims and enrollment discrepancies related to provider data
Manage other provider data management-related projects
Review and support the claims process for medical review and cost-saving initiatives
Maintain department statistics for quality improvement indicators, regulatory agencies, and certification bodies
Perform routine and moderately complex audits on medical review claims to identify exceptions
Research reviewed-claim issues to determine origins and appropriate resolutions
Summarize findings and recommendations in reports and distribute them to management
Communicate audit and review results with the claims department to improve processing and resolutions
Provide qualified data for training programs, policies, and procedures
Maintain current knowledge of Health Net products, policies, procedures, coding, industry regulations, and certification standards

Requirements

What you’ll need

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
High School Diploma or equivalent
Four years general data management experience in an automated claims processing, claims research, or provider maintenance environment
Some college coursework preferred
Current working knowledge of Health Net products, policies and procedures
Knowledge of contract and benefit plan coding
Knowledge of health insurance industry regulations and certification standards
Ability to audit and validate pre- and post-payment claims
Ability to audit provider data loaded into claims processing systems
Ability to research claims and enrollment discrepancies related to provider data

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation