Also referred to as: Claims Quality Auditor - Senior, Claims Quality and Compliance Auditor III
Requirements and Responsibilities

Claims Quality Auditor III audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor III makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor III typically reports to a supervisor or a manager. Claims Quality Auditor III is a specialist on complex technical and business matters. Work is highly independent. May provide a leadership role for the work group through knowledge in the area of specialization. To be a Claims Quality Auditor III typically requires 7+ years of related experience.

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