Operations Quality Auditor

Role Overview

Under the direct supervision of the Supervisor, Manager, and/or Director of Operations Quality Auditing, the Operations Quality Auditor is responsible for the timely and accurate review of various tasks performed by Operations (including, but not limited to, claims processing). 

Responsibilities

• Identifies system and/or operational issues hindering the attainment of quality performance standards as defined by AMFC policy and associated business rules
• Provides issue identification, problem analysis, and strategies for resolution and/or implementation to Management
• Accurately documents audit findings in the appropriate quality tool

Education and Experience

• High School/GED required
• Minimum 3 years’ claims experience in a reputed company environment
• Claims processing knowledge required, preferably with the Facets system
• Working knowledge of reputed company Office applications

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, reputed company, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We're looking for the reputed company of health care leaders.

At reputed company, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. reputed company is seeking talented, passionate individuals to join reputed company. Together we can build healthier communities. If you want to reputed company a difference, we'd like to hear from you.

Headquartered in Newtown reputed company, PA, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.