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Job Details

Performance Quality Auditor I

Company name
Concept Plus

Location
Waukesha, WI

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Profile

Role and Responsibilities:

The Performance Quality Auditor I is responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to review and audit of Department of Defense purchased care claims which provide services to military health beneficiaries.

Duties could include:



  • Evaluate the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
  • Identify, document, and report any transaction errors or communications issues in a timely manner to ensure prompt resolution.
  • Track and trend audit results, providing feedback to management.
  • Identify and report on systemic issues, which create ongoing quality concerns.
  • Generate monthly reports of audit findings, support clients with issues identified and develop reports to assist management with the information requested.
  • Produce other ad hoc reports as requested by internal and/or external clients.
  • Associate at this level conduct routine audits, generally related to a single function on a single systems platform for a single line of business.
  • Other duties as assigned.




Minimum Qualifications and Education Requirements:



  • Requires high school diploma or equivalent (GED).
  • Experience in enrollment and billing, claims and/or customer contact automated environment preferred.
  • Experience organizing and prioritizing in a fast-paced office environment in order to meet deadlines.
  • Strong analytical and research skills.
  • Must be self-motivated and detail-oriented.
  • Ability to acquire and perform progressively more complex tasks in a production environment.
  • Proficiency in written communications.
  • Associates must complete an SF86 Questionnaire for National Security Positions, fingerprint cards and receive a Favorable Determination of Trustworthiness from the Defense Health Agency Personnel Security Branch.




Preferred / Special Skills:



  • Knowledge of insurance industry and medical terminology preferred.
  • Bachelor’s degree preferred.


Company info

Concept Plus

Company Profile

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