Claims Quality Auditor II

The Claims Quality Auditor II works closely with the Claims Quality Auditing Manager to maintain up-to-date knowledge of healthcare trends, regulations, and policies. This position serves as a liaison between partnering departments, ensuring claims are processed according to regulatory guidelines, Medi-Cal standards, and contractual agreements. The role involves conducting audits of high dollar claims, provider disputes, and adjustments while collaborating with the Claims Operations Supervisor to improve departmental quality.