Quality Claims Auditor: This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data-entered information & by auditing service related information & invoice adjudication/payment for compliance w/ contract terms & Department/Regional policy & procedures. The auditor must be thoroughly familiar w/ outside medical systems & claims processing/adjudication processes. The Auditor must independently perform comprehensive audits of claims to source documents & identify inaccuracies. Conduct quality audits of claims, pre & post payments, utilizing appropriate sources of information, including eligibility, enrollment, provider contracts, policy & procedures. The position requires research, problem resolution & specialized knowledge in the areas of contracts, Medicare & Medi-Cal regulations & reimbursement rules, Multiplan & Beechstreet, Worker's Compensation, Coordination of Benefits & Third Party liability. The auditor must also be capable of developing a working relationship w/ regulatory agencies. The level of involvement depends on the specific location. Ensures timely intervention into the service quality issues in order to enhance service delivery & customer satisfaction.