Quality Auditor (Part C)

Tmf/C2C • Austin, TX

9d • Remote

About The Position

This position is located Remote United States. This position requires working weekends, and rotating holidays as needed. Please note the start date is on or after July 6, 2026. Position Purpose: Audits second level appeals of claims to ensure compliance with contract requirements and performs user testing and interface with the required systems.

Requirements

• High School Diploma or equivalent
• Three (3) years of general office experience
• College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
• One (1) year of Qualified Independent Contractor (QIC) appeals, dispute resolution experience or other healthcare appeals processes
• Resided in the United States for a minimum of three (3) years out of the last five (5) years? (Per Contract Requirement)

Nice To Haves

• Medicare Part C related appeals activities

Responsibilities

• Performs audits and examinations of case files to identify inaccuracies and non-compliance issues.
• Shares educational feedback, trends and insight individually and collectively with the staff.
• Performs data analysis to identify improvement opportunities in the appeals process and reduce unnecessary appeals.
• Provides quality and analytical support to the department including assisting senior analyst in data interpretation and preliminary analysis.
• Prepares training materials and provides technical training to employees.

Benefits

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED