Senior Clinical Quality Auditor performing internal audits, analyzing results, and collaborating with clinical operations teams at DaVita. Assisting leadership with daily operations of the Clinical Quality Auditing team.
About the role
- Claims Auditor conducting audits of health and dental providers for compliance. Working at Alberta Blue Cross, offering services to over 1.8 million members.
Responsibilities
- Conduct dental and/or health audits/investigations and ensure compliance
- Field work to collect documentation
- Complete claims analysis to ensure compliance with provider agreements
- Prepare working papers, letters, and reports
- Issue reports on claims and/or monetary adjustments
- Develop and maintain good relationships with service providers and internal partners
- Address internal and external clients’ needs
Requirements
- Post-secondary education in science, business, criminal justice, health care, and/or law
- Relevant experience in law enforcement can be considered in lieu
- Investigative designation such as CFI or CFE is preferable
- Exceptional written and verbal communication skills
- Experienced in investigation interviewing
- Commitment to quality customer service
- Ability to establish and maintain effective relationships with customers
- Knowledge of databases and ability to analyze large amounts of data using Microsoft Excel
- Experience in the dental and health care benefits industry is preferable
Benefits
- Health coverage for over 1.8 million members
- Opportunities for career growth
- Healthy work-life balance
- Inclusive employer supportive of diverse backgrounds and experiences
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Lead IT Auditor managing complex IT, information security, and integrated audits at Navy Federal. Collaborating with audit staff and stakeholders to ensure effective auditing practices.
Staff Auditor I executing financial, operational, compliance, and IT audits while improving risk management processes. Collaborating with stakeholders and reporting findings for enhanced effectiveness.
Assistant Tax Auditor in Athens with Forvis Mazars collaborating on tax audit engagements and developing technical knowledge in tax compliance.
Internal Auditor for PromptCare Companies responsible for managing documents and audits. Ensuring compliance and communication with team, enhancing documentation processes.
Internal Staff Auditor conducting audits related to payments and the card industry at Fiserv. Collaborating with business departments to ensure compliance with policies and regulations.
Supplier Quality Audit Lead managing GMP and Quality Systems compliance audits for GSK manufacturing suppliers. Responsible for maintaining supplier compliance and effective communication with stakeholders.
Doc Auditor responsible for processing and reviewing closing - related documentation at ServiceLink. Supports Doc Auditors and ensures compliance with company and client requirements.
Conducting premium audits for various coverage lines including Workers Compensation and General Liability. Ensuring compliance and maintaining regulatory standards as part of the audit process.
Business Process Auditor Associate providing assurance and advisory services within a health plan environment. Gaining experience in evaluating governance, risks, and controls across health plan operations.