Senior Quality Auditor

• Log into System daily to access inquiries
• Log into Client Letter or Sharepoint daily to access letters
• Log into several applications to obtain the information needed to complete the inquiry
• Work in assigned queues, documenting and closing all completed inquiries, then completing letter to member documenting work completed
• Work professionally as a liaison with all levels of management and departments, i.e., Enrollment, Billing, Appeals, Claims, Brokers, Account Executives, Live
• There are 2 main types of inquiries/requests: Privacy Documents, and Written Correspondence




• Validate HIPAA documents.
• Upload documents to system and send a valid or invalid letter to the member. Validation ensures that the forms are completed correctly and that it is legal for our reps to speak to parties other than our members.




• Send written Correspondence, ad hoc letters, blank forms/applications, duplicate tax or claim information to members, in response to their questions/requests




• May need to locate the requested information from accessing 1 or multiple systems
• Accumulation letters, exhaust letters
• Provide information for the foreign travel letters
• Confirm premium information and validate effective dates, etc
• Process HIPAA forms, go through validation, send appropriate letters




• Follow up with other departments by phone or email for additional information, as needed
• Work priority requests, as assigned
• All documented actions and must be completed the same day, i.e. fax, mail, email, route to another area
• Other duties as assigned.

Qualifications

Education

• High School Diploma or College Degree preferred

Experience

• Minimum 3 years of experience in the health insurance industry with a combined focus on production and quality. College degree in lieu of experience will be considered.

Knowledge, Skills, Abilities

• Demonstrated ability to deal effectively with others and have a willingness to be a team player
• Demonstrated ability to communicate via email
• Familiarity with data processing and the ability to work with documented policies and procedures
• Health Rules, Excel, Word, SharePoint, and any other system that logs productivity and triages workflow

Health Insurance,Data Processing,computer knowledge