Quality Assurance Auditor

Allied Benefit Systems•Chicago, IL

3d•Remote

About The Position

The Quality Assurance Auditor will be responsible for the completion of multiple audit tasks including but not limited to auditing the building of plan coders as needed for all new and existing revisions, along with compiling and reporting results and trends accurately. The QA Auditor is also responsible for auditing outgoing correspondence from the Medical Review, Appeals, and Refund teams, as well as complete audit of claim adjustments by the Rapid Response team. The QA Auditor will interpret the benefits in the plan documents to determine how benefits are payable and tracked/reported in the QicLink system.

Requirements

Bachelor's degree or equivalent work experience required.
Minimum 5 years of comprehensive experience with auditing medical, dental, and vision claims required
Proficient in Microsoft Word and Microsoft Excel
Some familiarity with plan coding
Strong written and verbal communication skills required
Ability to effectively manage assigned workload, including multiple tasks and competing priorities

Responsibilities

Log and track data to be audited
Audit outgoing correspondence from the Medical Review, Appeals, and Refund teams
Conduct complete audit of claim adjustments by the Rapid Response team
Communicate and coordinate with other departments involved in the audit process
Audit new and existing plans built by plan coders for all new and existing revisions
Assist with current audit programs in place as well as identifying ways to improve audit results
Track and report audit trends and communicate training requirements to Management based on audit results
Monitor and track audit progress to ensure all audit tasks are complete by the determined deadline
Audit data for accuracy as well as workflow compliance
Other duties as assigned