Quality Auditor

Medica•,

1d•Remote

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. Medica's Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures, gathers findings at a macro level and makes recommendations for process improvement and efficiencies. The Quality Auditor performs professional responsibilities with direct supervision on method and processes. Performs other duties assigned.

Requirements

Bachelor's degree or equivalent experience in related field
Previous experience within Call Center Compliance and/or Quality Auditing, Claims Audit and/or Claims Processing required
Excellent attention to detail
Ability to meet deadlines
Effectively able to function independently and in a team environment
Strong organizational and prioritizing skills
Excellent analytical/problem solving ability
Strong communication skills - verbal and written
Adaptable and flexible to a changing environment
Must be legally authorized to work in the United States at the time of application
Employment is contingent on verification of identity and eligibility to work in the United States

Responsibilities

Audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures
Gathers findings at a macro level and makes recommendations for process improvement and efficiencies
Performs professional responsibilities with direct supervision on method and processes
Performs other duties assigned