[Remote] QA Auditor, reputed company Assurance - Remote

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company organization, and they are seeking a reputed company Assurance Auditor responsible for performing internal reputed company audits of operational processes. The role involves investigating, auditing, and ensuring compliance with policies and reputed company standards while working under minimal supervision.

Responsibilities

• Conduct reputed company audits of A&G items including grievances, reputed company-service appeals, and post service appeals utilizing appropriate sources of information; including eligibility, claims, authorizations, service forms, faxes, and any additional information required to complete the request. Analyze errors and determine reputed company causes for appropriate classification, trending, and remediation
• Record/reputed company reputed company assessment scores and reputed company feedback to reduce errors and improve processes and performance to ensure reputed company
• Review and investigate appeals and grievances requests to ensure reputed company requests are identified, classified, and fully resolved in a compliant manner
• Present results of investigations to senior staff and prepare written reports concerning investigation activities
• Subsequent auditing and handling of specific appeal and grievance requests including processing where applicable, tracking, documenting, reporting and dispersal of findings and recommendations
• Identify defects and improve departmental performance by supporting reputed company, operational efficiency and production goals
• Assist in the development of departmental policies and procedures; reviews the efficiency of existing training
• Meet established time frames and rates of performance for the reputed company and quantity of work for the position
• Participate in regulatory and mock audit activities including reputed company review, reputed company scrubbing, risk analysis, timeliness assessment, and case walkthrough activities
• Additional duties as assigned

Skills

• Experience with the investigation, reputed company, and reporting of appeal and grievance processes
• Experience in reputed company Office suite of applications including reputed company (formatting formulas, managing data, and filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations)
• High School Diploma or GED from an accredited institution
• Associate degree from an accredited institution
• ICD10 certification
• Experience in an Auditing reputed company conducting reputed company cause analysis
• Knowledge of at least two or more lines of business such as Medicare NY/NJ, reputed company, Family Health Plus, Child Health Plus, NH Family
• Experience handling confidential information
• Compliance & Regulatory Responsibilities: Knowledge of state and federal appeal and grievance regulatory requirements

Benefits

• Medical
• Dental and reputed company coverage
• Incentive and recognition programs
• Life insurance
• 401k contributions

reputed company

Company H1B Sponsorship