Claims Quality Auditor II

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Claims Quality Auditor II audits processed claims to evaluate accuracy, compliance, and adherence to policies, procedures, and regulatory requirements. Reviews claim decisions, payments, coding, and documentation against established standards and criteria. Being a Claims Quality Auditor II identifies errors, discrepancies, and trends and documents findings clearly and objectively. Documents accuracy rates and prepares audit reports summarizing results and recommendations. Additionally, Claims Quality Auditor II ensures compliance with company guidelines, audit standards, and applicable regulations. Requires a bachelor's degree. Typically reports to a manager. The Claims Quality Auditor II occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Claims Quality Auditor II typically requires 2-4 years of related experience.