Job Title : Operations Quality Auditor
Under the direct supervision of the Supervisor, Manager and/or Director of Operations Quality Auditing, responsible for the timely and accurate review of various tasks performed by Operations (including, but not limited to, claims processing, call handling and member/provider data maintenance).
- 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.
Job Related Experience and Skills
- 3-5 years’ experience
- Minimum 3 years’ claims experience in a Medicaid environment
- Bachelor’s Degree
- Other Skills:
- Claims processing knowledge required, preferably with the Facets system
- Working knowledge of Microsoft Office applications
- Experience in call center ops and member/provider database maintenance preferred
AmeriHealth Caritas - 22 months ago
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