Quality Auditor

Quality Auditor Job Category: Administrative Support Position Purpose: Audits second level appeals of claims to ensure compliance with contract requirements and performs user testing and interface with the required systems. Essential 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. Minimum Qualifications: Education: High School Diploma or equivalent Experience: 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. One (1) year of Qualified Independent Contractor (QIC) appeals, dispute resolution experience or other healthcare appeals processes Managed Care, preferred Resided in the United States for a minimum of three (3) years out of the last five (5) years? (Per Contract Requirement) 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 EOE Vet/Disability

Created: 2026-04-01