Quality Auditor

HealthEdge

Quality Auditor performing audits on health plan claims for UST HealthProof. Collaborating with associates to ensure quality in health plan operations and reporting performance results.

Posted 5/28/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $35,000 - $48,000 per yearWebsite

About the role

Key responsibilities & impact

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 of improvement.
Collate, compile and reports 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 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.

Requirements

What you’ll need

High School Diploma or GED required
3 years health plan claims auditing operations experience required
Medicare 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

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims auditingMedicare claims auditingdata analysisSLA analysisKPI analysis

Soft Skills

communicationcollaborationfeedbackcoordination

Certifications

High School DiplomaGED