Quality Audit Analyst
Core
Planning and conducting detailed audits of business transactions (claims, inquiry, membership) to ensure adherence to internal controls, model audit rules, and standard business processes.
Role type
Quality Audit Analyst
Builds
Audit reports and compliance verification for health insurance operations
Domain
Health Insurance / Claims Processing
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Auditing claims/inquiry/membership, Knowledge of Blue Chip processing systems (BlueSTAR, CFE), Medical terminology, Analytical skills, Research skills, Knowledge of state contract provisions, PC proficiency (Word, Excel, PowerPoint, EPPS, NICE, Lotus Notes)
Preferred skills
Quality audit experience, Knowledge of health insurance products
Responsibilities
Review business transactions to assure internal controls are adhered to, Verify processing is timely, accurate, and complete in appropriate systems, Analyze programs related to quality and performance
Seniority
Mid-level, hands-on IC