Claims, Operations Quality Auditor

Amerihealth Caritas•Tinicum Township, PA

4d•Hybrid

About The Position

The Operations Quality Auditor is responsible for timely and accurate review of various tasks performed by Operations, including Claims. The role works under the direct supervision of the Supervisor, Manager, and/or Director of Operations Quality Auditing. The position uses AMFC policy and associated business rules to assess quality performance, identify operational or system issues, analyze problems, recommend resolution strategies, and document audit findings in the appropriate quality tool. This is a hybrid role requiring the associate to work in the office at least three days per week, including Tuesdays and Wednesdays. Reliable high-speed internet access is required to support daily responsibilities; the stated minimum is 50 Mbps download and 5 Mbps upload.

Requirements

High school diploma or GED.
At least 3 years of claims experience in a Medicaid environment.
Claims processing knowledge.
Working knowledge of Microsoft Office applications.
For hybrid work, access to reliable high-speed internet with at least 50 Mbps download and 5 Mbps upload.

Nice To Haves

Experience with the Facets system is preferred.

Responsibilities

Review Operations tasks, including Claims, accurately and in a timely manner.
Identify system and operational issues that hinder achievement of quality performance standards defined by AMFC policy and associated business rules.
Provide issue identification, problem analysis, and strategies for resolution and/or implementation to Management.
Accurately document audit findings in the appropriate quality tool.