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Role Description

Working independently and in groups, the Quality Assurance Auditor will be responsible for the completion of multiple audit tasks including but not limited to:

• Auditing the builds of plan coders as needed for all new and existing revisions.
• Compiling and reporting results and trends accurately.
• Auditing outgoing correspondence from the Medical Review, Appeals, and Refund teams.
• Completing audits of claim adjustments by the Rapid Response team.
• Interpreting benefits in the plan documents to determine how benefits are payable and tracked/reported in the QicLink system.

Qualifications

• Bachelor's degree or equivalent work experience required.
• Minimum 5 years of comprehensive experience with auditing medical, dental, and vision claims required.
• Proficient in Microsoft Word and Microsoft Excel.
• Some familiarity with plan coding.
• Strong written and verbal communication skills required.
• Ability to effectively manage assigned workload, including multiple tasks and competing priorities.

Requirements

• Log and track data to be audited.
• Audit outgoing correspondence from the Medical Review, Appeals, and Refund teams.
• Conduct complete audit of claim adjustments by the Rapid Response team.
• Communicate and coordinate with other departments involved in the audit process.
• Audit new and existing plans built by plan coders for all new and existing revisions.
• Assist with current audit programs in place as well as identify ways to improve audit results.
• Track and report audit trends and communicate training requirements to Management based on audit results.
• Monitor and track audit progress to ensure all audit tasks are complete by the determined deadline.
• Audit data for accuracy as well as workflow compliance.
• Other duties as assigned.

Benefits

• Competitive Benefit Package including Medical, Dental, Vision, Life & Disability Insurance.
• Generous Paid Time Off.
• Tuition Reimbursement.
• EAP (Employee Assistance Program).
• Technology Stipend.

Company Description

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.