Claims Quality Inspector

A company is looking for a Claims Quality Inspector.

Key Responsibilities :

Conduct accurate and timely quality reviews of claim adjudication activities

Perform quality audits on Membership eligibility and enrollment entry

Document findings in the QC tracking system and communicate error determinations

Required Qualifications :

High School Diploma or GED required

At least 2 years of experience in a Claims or QC / Inspector role within the managed care industry, or 5 years of experience processing medical claims

Bachelor's degree and / or Claims adjudication or medical billing / coding certification preferred

Prior experience within the Medicare, Medicaid, or regulated Managed Care payer environment is preferred

Pre-employment background check required