ImageNetLLC
Claims Quality Auditor - Remote
Tampa, Florida, United States · Full-time
Sponsorship not specifiedDetected 33 days ago
AuditingCommunicationProblem SolvingClaims Management
About the role
- The Claims Quality Auditor plays a key role in ensuring the accuracy, compliance, and effectiveness of claims processing and provider dispute resolution.
- The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.
- The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.
Responsibilities
- Perform detailed audits of denied, underpaid, and processed claims using EZCap to assess accuracy and compliance with provider contracts and regulatory guidelines.
- Identify root causes and work with relevant teams to implement corrective actions and process improvements.
- Develop and track performance related to claims accuracy, turnaround time, and dispute resolution efficiency.
- Support training initiatives by identifying knowledge gaps and assisting in the development of updated procedures and documentation based on audit results.
- This role is responsible to partners closely with cross-functional teams to drive continuous improvement and operational excellence.
Requirements
- Familiarity with Medi-Cal and Commercial insurance claim
- Experience with other claim adjudication platforms and provider systems.
- Familiarity with DHCS, DMHC, CMS dispute handling regulations.
- High school diploma or equivalent
- At least 3-5 years of Quality Analyst in healthcare, TPA, or health plan settings/ healthcare claims or in a claims processing/adjudication environment
- Strong analytical and problem-solving skills
- Excellent verbal and written communication
- Attention to detail in documentation and compliance
- Ability to manage multiple tasks and meet deadlines
- Paid training to set you up for success
Nice to have
- Hands-on experience with EZCap (strongly preferred)
Compensation
- The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.
Benefits
- Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
- Paid Time Off (PTO)
- Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide.
- The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers.
Apply directly at ImageNetLLC →Create a free account for alerts like thisView ImageNetLLC immigration profile
This listing is sourced directly from ImageNetLLC's careers page and normalized into a canonical job model.