Skills & Competencies for Claims Quality Auditor III

Claims Quality Auditor III job profile

Book a Demo and Receive a Sample Job Profile

JOB SUMMARY for Claims Quality Auditor III

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

JOB RESPONSIBILITIES for Claims Quality Auditor III

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

Claims Quality Auditor III SALARY RANGE

BASE 50%
$64,003
TOTAL 50%
$66,018
Job Level
P04
Job Code
HC07000628
Education/Degree
Associate's Degree
Reports To
Supervisor or Manager

Claims Quality Auditor III 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 III 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 III

1 Industry Competency – Insurance Industry
Proficiency Level -3
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)
Cites different types of insurance policies and describes the advantages and disadvantages of each.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Compiles insurance quotes based on customer information and rates for insurance policies.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Applies risk management techniques to minimize financial impacts in insurance services.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Contributes to the development of insurance risk mitigation strategies to drive process improvements.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Builds claim roadmaps and substantiation plans in compliance with insurance risk management practices.
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)
Cites examples of the legal principles of insurance applicable to multiple types of insurance products.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Assists in assessing regulatory risks to ensure insurance operations meet compliance and regulatory obligations.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Adopts legal and regulatory initiatives to assess possible risks and maintain insurance solvency.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Directs the regulation of insurance products to ensure insurance policy provisions comply with state laws.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Builds policy and regulatory tools to monitor and assess compliance levels with insurance laws and regulations.
See 4 More Skill Behaviors
3 Claims Quality Auditor III - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Quality Auditor III
Proficiency Level - 4
5 Competency for - Claims Quality Auditor III
Proficiency Level - 5

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

1 Job Family Competencies – Quality Assurance
Proficiency Level -3
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)
Describes the significance of data warehousing best practices in maintaining quality assurance.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Compiles statistical data and narrative reports to summarize quality assurance findings.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Executes quality chart audits to address quality assurance-related issues and identify areas for improvement.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Guides the quality improvement teams to minimize quality issues while recommending process improvements.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Develops quality assurance activities to promote adherence to standards and best practices.
See 4 More Skill Behaviors
2 Job Family Competencies – Quality Audit
Proficiency Level -4
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)
Explains the relationship of the International Organization for Standardization (ISO) 9001 standard in the quality audit.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Compiles all quality-related documentation to easily access regulatory audits.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Implements appropriate audit procedures to ensure high-quality standards and compliance.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Determines the need for computer-assisted audit techniques and develops quality audit programs for process improvement.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Champions quality self-assessment programs to build and sustain an audit-ready-now environment.
See 4 More Skill Behaviors
3 Claims Quality Auditor III - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Quality Auditor III
Proficiency Level - 4
5 Competency for - Claims Quality Auditor III
Proficiency Level - 5

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

1 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -3
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)
Describes the purposes and benefits of Standard Operating Procedures (SOP).
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Documents the SOP drafts and outlines for final approval.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Implements the use of SOP throughout our business to drive efficiency.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Enhances the SOP management system to improve efficiency and user experience.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Designs a Standard Operating Procedure (SOP) strategy to align with our business objectives.
See 4 More Skill Behaviors
2 Core Competencies – Attention to Detail
Proficiency Level -4
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Explains why attention to detail plays an important role in own function or unit.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Processes limited amounts of detailed information with reasonable accuracy.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Processes large quantities of detailed information with high levels of accuracy.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Demonstrates expertise in quality assurance tools, techniques, and standards.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Designs techniques for measuring the cost and impact of errors.
See 4 More Skill Behaviors
3 Claims Quality Auditor III - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Quality Auditor III
Proficiency Level - 4
5 Competency for - Claims Quality Auditor III
Proficiency Level - 5

Summary of Claims Quality Auditor III skills and competencies

There are 7 hard skills for Claims Quality Auditor III, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
2 general skills for Claims Quality Auditor III, Quality Assurance, Quality Audit.
8 soft skills for Claims Quality Auditor III, 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 III, he or she needs to be skilled 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.