Auditor

• Conduct routine and targeted audits of appeals and grievances cases
• Ensure adherence to applicable federal and state regulations, accreditation standards, organizational policies, and operational procedures
• Evaluate case quality, identify trends and improvement opportunities
• Support corrective action initiatives, provide reporting, training, and guidance to appeals and grievances leadership
• Participate in quality improvement initiatives focusing on compliance, efficiency, and member experience
• Assist with the development and delivery of quality, compliance, and process-related training.

Appeals & Grievances Quality Auditor ensuring regulatory compliance for a health plan

Appeals & Grievances Quality Auditor

Appeals & Grievances Quality Auditor responsible for audits and quality assurance in a nonprofit health plan. Analyzing case compliance and supporting corrective actions for improved member experience.

Auditor jobs in North Dakota

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Appeals & Grievances Quality Auditor