Claims Quality Auditor jobs in Philadelphia, PA

Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

P
Quality Auditor
  • PCI Pharma Services
  • Philadelphia, PA FULL_TIME
  • Life changing therapies. Global impact. Bridge to thousands of biopharma companies and their patients.


    We are PCI.


    Our investment is in People who make an impact, drive progress and create a better tomorrow. Our strategy includes building teams across our global network to pioneer and shape the future of PCI.

    JOB SUMMARY:

    This position is responsible for providing the direction, organization, alignment, monitoring and cGMP compliance to ensure the successful, cost effective, timely and safe processing of customer orders. The position audits production room documentation, checks equipment challenges and hourly in-process inspections have been performed, ensures samples have been taken, and reviews room for 5S Compliance. These associates are responsible for performing real time batch record and documentation review during batch processing in order to drive improvements into our Right First Time (RFT) metrics. They are also responsible for leading and realizing continuous quality and process improvements on the production floor by mentoring, coaching and training their operational counterparts.

    ESSENTIAL DUTIES AND RESPONSIBILITIES :

    • Perform production room approvals after product and lot changes
    • Verifies first piece inspection to ensure finished goods code, format, and expiration date are correct
    • Ensure equipment is packaged within validated parameters and equipment calibration dates on all process equipment are within required specifications. If not, this individual will contact the appropriate personnel to recalibrate and/or remediate the issue.
    • Review batch record(MPI)to ensure equipment challenges and hourly inspections have been conducted and any non-conformances are addressed appropriately. Conduct periodic checks to confirm hourly inspections are being performed correctly and on track to meet AQL requirements.
    • Review sampling pages to ensure samples have been taken, labelled and documented appropriately
    • Audit production room to ensure Cleaning and Use logbooks, Mechanical Set-up logbooks, and Preventive Maintenance logbooks have been completed accurately and timely.
    • Confirm package (unit) functionality (perfs, peel, push, seals, etc.)
    • Check to ensure portable equipment has been cleaned and documented correctly on quality form.
    • Audit production personnel to ensure the job is performed safely including wearing required personal protective equipment.
    • Ensure recovery stations are segregated from product flow.
    • Confirm bulk material and components for job are correct and kept covered.
    • Review each equipment clean room logbooks for correct clean room, entries are complete, correct and legible.
    • Review temperature and humidity data to ensure within acceptable job parameters.
    • Document audits using the Quality Auditor checklist listing the room, production job description, and date when the audit was conducted.
    • Identify proactively gaps in batch records and PDR's to mitigate deviations and documentation errors.
    • Participate on improvement teams (i.e. FMEA's, Kaizen, batch record etc.) as needed.
    • Support Root Cause Analysis as needed.
    • Write quality event notifications for issues encountered on the production floor.
    • Ensure 5s Compliance.
    • This position may require overtime and/ or weekend work.
    • Must have knowledge of and adherence to all PCI, cGMP, and GCP policies, procedures and rules.
    • Must be dependable in work attendance.
    • May perform duties of Quality Coordinator.

    EDUCATION OR EQUIVALENT:

    • High School Diploma required
    • 2 - 4 years relevant experience in production, equipment and or process.
    • Packaging, Pharmaceutical, Bio-Pharmaceutical, and/or Medical Device background is preferred LANGUAGE SKILLS:
    • Must possess good analytical skills and excellent verbal and written communication skills.
    • Must demonstrate effective listening, coaching and interpersonal communications skills.

    KNOWLEDGE/SKILLSREQUIREMENTS:

    • Must be dependable and show initiative to improve safety, quality, throughput and cost performance.
    • Must be willing to work overtime and flexible in regards to working on all 3 shifts.
    • Able to balance multiple issues simultaneously in a fast paced environment.
    • Needs good problem solving skills, should be detail oriented and well organized.

    COMPUTER SKILLS:

    • Must be computer literate with past experience using MS Office, Lotus Notes, spreadsheets and ERP systems.

    PHYSICAL DEMANDS:

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be physically capable to perform the above duties with or without reasonable accommodations which may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand; walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision.

    WORK ENVIRONMENT:

    The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

    EQUAL OPPORTUNITY EMPLOYER/VET/DISABLED

    Join us and be part of building the bridge between life changing therapies and patients.


    LSNE is an EEO/AA Employer and all qualified applicants will receive consideration for employment without regard to, their race, color, religion, sex, age, national origin, ancestry, sexual orientation, gender identity, disability, protected genetic information, protected veteran status, military service, or other protected status. The Company’s EEO policy, as well as its affirmative action obligations, include the full and complete support of The Company.

     

  • 1 Month Ago

N
Medical Claims Auditor
  • National Elevator Industry Benefit Plans
  • Newtown, PA FULL_TIME
  • Claims Auditor - Trainer Well established employer in Newtown Square, Delaware County, Pennsylvania has a need for a full-time Claims Auditor - Trainer. The company offers a competitive salary, excell...
  • 9 Days Ago

N
Medical Claims Auditor
  • National Elevator Industry Benefit Plans
  • Newtown, PA FULL_TIME
  • Claims Auditor - Trainer Well established employer in Newtown Square, Delaware County, Pennsylvania has a need for a full-time Claims Auditor - Trainer. The company offers a competitive salary, excell...
  • 9 Days Ago

B
Medical Stop Loss - Claims Auditor
  • Berkshire Hathaway Specialty Insurance
  • Plymouth Meeting, PA FULL_TIME
  • Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outs...
  • 1 Month Ago

H
Lead Quality Auditor
  • HOLTEC INTERNATIONAL
  • Camden, NJ FULL_TIME
  • Essential Job FunctionsPerformance of internal and external audits for the Company. Audits include both a programmatic review as well as implementation verification. Work would include a) preparation ...
  • 13 Days Ago

P
Quality Auditor (2nd shift)
  • PCI Pharma Services
  • Philadelphia, PA FULL_TIME
  • Life changing therapies. Global impact. Bridge to thousands of biopharma companies and their patients.We are PCI. Our investment is in People who make an impact, drive progress and create a better tom...
  • 13 Days Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Claims Quality Auditor jobs found in Philadelphia, PA area

P
Quality Auditor
  • PCI Pharma Services
  • Philadelphia, PA
  • Life changing therapies. Global impact. Bridge to thousands of biopharma companies and their patients. We are PCI. Our i...
  • 4/19/2024 12:00:00 AM

I
Quality Auditor
  • INTELLISWIFT INC
  • West Point, PA
  • Job ID: 24-02290 Qualifications: Position Qualifications: Education Minimum Requirement: B.S., M.S. and/or PhD. degree i...
  • 4/19/2024 12:00:00 AM

I
Quality Auditor
  • Intelliswift Software Inc
  • West Point, PA
  • Qualifications: Position Qualifications: Education Minimum Requirement: B.S., M.S. and/or PhD. degree in an appropriate ...
  • 4/19/2024 12:00:00 AM

A
Lead Quality Auditor
  • Artech LLC
  • West Point, PA
  • LEAD QUALITY AUDITOR WEST POINT PA 100% Remote Role! The pay ranges between $28.00 - $31.83 an hour! Required Skills: B....
  • 4/19/2024 12:00:00 AM

P
Sr. Quality Auditor (Remote)
  • Primary Talent Partners
  • West Point, PA
  • Primary Talent Partners has a remote 12-month contract Sr. Quality Auditor opening with a Pharmaceutical client based in...
  • 4/19/2024 12:00:00 AM

T
Quality Auditor - Scientific - III
  • Talent Software Services, Inc.
  • West Point, PA
  • " Maintain an expert level of knowledge related to GMP requirements and industry trends as described in applicable world...
  • 4/19/2024 12:00:00 AM

T
CRO Quality Auditor I TD0009 | Bachelor's degree required
  • TechData Service Company LLC
  • Newark, DE
  • Job Description Job Description Job Description: Audit scientific data for various clinical and nonclinical study record...
  • 4/19/2024 12:00:00 AM

L
Quality Auditor - Scientific
  • LanceSoft, Inc.
  • Lansdale, PA
  • Qualifications: Bachelor degree (B.S.) in an appropriate Science or Engineering discipline (engineering, chemistry, biol...
  • 4/16/2024 12:00:00 AM

Philadelphia, sometimes known colloquially as Philly, is the largest city in the U.S. state and Commonwealth of Pennsylvania, and the sixth-most populous U.S. city, with a 2017 census-estimated population of 1,580,863. Since 1854, the city has been coterminous with Philadelphia County, the most populous county in Pennsylvania and the urban core of the eighth-largest U.S. metropolitan statistical area, with over 6 million residents as of 2017[update]. Philadelphia is also the economic and cultural anchor of the greater Delaware Valley, located along the lower Delaware and Schuylkill Rivers, wit...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Auditor jobs
$48,554 to $59,512
Philadelphia, Pennsylvania area prices
were up 1.0% from a year ago

Claims Quality Auditor in Bloomington, IN
Evaluates claims activities of other departments and / or companies.
December 05, 2019