Skills & Competencies for Claims Quality Auditor II

Claims Quality Auditor II job profile

Book a Demo and Receive a Sample Job Profile

JOB SUMMARY for Claims Quality Auditor II

Audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures.

JOB RESPONSIBILITIES for Claims Quality Auditor II

Selects claims through random processes and/or other criteria. Makes recommendations to improve quality, workflow processes, policies and procedures.

Claims Quality Auditor II SALARY RANGE

BASE 50%
$56,783
TOTAL 50%
$58,355
Job Level
P03
Job Code
HC07000627
Education/Degree
Associate's Degree
Reports To
Supervisor or Manager

Claims Quality Auditor II Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Claims Quality Auditor II skill and competencie below to view definitions.
INDUSTRY COMPETENCIES JOB FAMILY COMPETENCIES CORE COMPETENCIES
BOOK A DEMO

7 hard skills or competencies (industry competencies) for Claims Quality Auditor II

1 Industry Competency – Insurance Industry
Proficiency Level -2
Skill definition-Applying knowledge of the insurance industry to provide risk management services and protection to various individuals from financial loss.
Level 1 Behaviors
(General Familiarity)
Names the commonly used tools and techniques for insurance planning and risk management.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Reports any discrepancies encountered in reviewing policy records and documentation.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Verifies received insurance coverage and damage reports to ensure accurate processing of claims.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Provides technical guidance to staff on claim investigation to ensure accurate insurance claims processing.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Pursues creative initiatives that may differentiate our business and give us a competitive advantage.
See 4 More Skill Behaviors
2 Industry Competency – Insurance Legal and Regulatory Environment
Proficiency Level -3
Skill definition-Creating, executing, and adhering to state and federal laws governing insurance operations to ensure financial security and consumer protection.
Level 1 Behaviors
(General Familiarity)
Explains the application of insurance regulatory laws to avoid civil penalties and license suspension.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Supports the execution of a legal and regulatory framework to promote strict insurance compliance.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Performs compliance reviews to determine possible violations and deficiencies in insurance regulations.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Trains teams on new laws and regulations to reduce liability risks and compliance violations.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Establishes best practices in creating insurance laws and regulations to prevent frauds and malpractices.
See 4 More Skill Behaviors
3 Claims Quality Auditor II - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Quality Auditor II
Proficiency Level - 4
5 Competency for - Claims Quality Auditor II
Proficiency Level - 5

2 general skills or competencies (Job family competencies) for Claims Quality Auditor II

1 Job Family Competencies – Quality Assurance
Proficiency Level -2
Skill definition-Verifying the adherence of product with required specifications and expectations to track and resolve deficiencies prior to product release.
Level 1 Behaviors
(General Familiarity)
Lists the methods involved in documenting obtained data during quality assurance activities.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Supports the quality assurance team in implementing quality assurance systems.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Partners with internal and external stakeholders to develop data quality assurance plans.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Provides recommendations on long-term improvements of the company-wide quality assurance process.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Monitors compliance of all projects with quality assurance guidelines.
See 4 More Skill Behaviors
2 Job Family Competencies – Quality Audit
Proficiency Level -3
Skill definition-Examining the conformance of a quality system to comply with standard specifications or procedures of the product, design, process, and system.
Level 1 Behaviors
(General Familiarity)
Locates the appropriate quality tool for documenting audit findings.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Supports prospective and retrospective audits to monitor quality and compliance.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Performs trend analysis of audit results in order to identify quality system deficiencies.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Sets audit procedures to monitor data quality following review of varying data and audit reports.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Leads all facets of audit projects, from implementation to completion to deliver a quality product.
See 4 More Skill Behaviors
3 Claims Quality Auditor II - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Quality Auditor II
Proficiency Level - 4
5 Competency for - Claims Quality Auditor II
Proficiency Level - 5

8 soft skills or competencies (core competencies) for Claims Quality Auditor II

1 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -2
Skill definition-A set of written instructions that describes the step-by-step activities to complete tasks in compliance with business standards and industry regulations.
Level 1 Behaviors
(General Familiarity)
Lists the typical processes of SOP development.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Supports the analysis of our business and operations processes for SOP design and development.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Researches new tools and techniques for SOP daily management.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Resolves complex issues arising from SOP practices; develops preventative solutions accordingly.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Monitors industry for SOP trends and best practices; makes recommendations about those that benefit our business.
See 4 More Skill Behaviors
2 Core Competencies – Attention to Detail
Proficiency Level -3
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Lists the traits of an employee showing great attention to detail.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Utilizes specific approaches and tools for checking and cross-checking outputs.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Uses tools to organize and monitor work progress.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Manages training to improve staffs' concentration and attention to detail.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Learns from previous works' strengths and weaknesses to guide new projects.
See 4 More Skill Behaviors
3 Claims Quality Auditor II - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Quality Auditor II
Proficiency Level - 4
5 Competency for - Claims Quality Auditor II
Proficiency Level - 5

Summary of Claims Quality Auditor II skills and competencies

There are 7 hard skills for Claims Quality Auditor II, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
2 general skills for Claims Quality Auditor II, Quality Assurance, Quality Audit.
8 soft skills for Claims Quality Auditor II, Standard Operating Procedures (SOP), Attention to Detail, Honesty And Integrity, etc.
While the list totals 17 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Claims Quality Auditor II, he or she needs to be proficient in Standard Operating Procedures (SOP), be skilled in Attention to Detail, and be skilled in Honesty And Integrity.

It's Easy to Get Started

Get the precision you need to assess, hire, and develop top talent with skills and competencies – see how with a personalized demo.