Claims Quality Assurance Inspector

A company is looking for a Claims Quality Assurance Inspector.

Key Responsibilities :

Conduct quality reviews of claim adjudication and enrollment activities for compliance with established guidelines

Perform quality audits on membership eligibility and enrollment accuracy in line with regulatory standards

Document findings in the QC tracking system and communicate error determinations clearly

Required Qualifications :

High School Diploma or GED required

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

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

Prior experience in Medicare, Medicaid, or regulated Managed Care environments preferred

Pre-employment background check required