Sr. Associate - Health Claims Quality Auditor

Job Description:

Our Senior Quality Associates get to: Define Sutherland’s reputation: Oversee and manage performance and service quality to guarantee customer satisfaction Strengthen relationships: Establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations Keep management updated: Relay important information in the form of timely and accurate reports Impact the bottom line: Produce solid and effective strategies based on accurate and meaningful data reports and analysis and/or keen observations. Experience in US Healthcare, Knowledge in handling claims process. (Commercial and/or Medicaid). Should have extensive experience in handling high dollar claims.

Requirements:

• Understanding of standard claim forms such as CMS-1500 and UB-04.
• Minimum of 2 to 3 years of direct experience in medical claims processing, medical billing, or healthcare auditing.
• Ability to spot minor billing errors, discrepancies, or potential fraud
• Strong written and verbal communication skills to report audit findings clearly
• Expert knowledge of complex commercial payer contracts, reimbursement methodologies, and federal Medicare/Medicaid regulations.
• Experience with process documentation
• Ability to work in MS Office
• Ability to work in a fast-paced environment
• Pro-active in developing trust and professional rapport with employees and team members; work as a team-player
• Have strong analytical skills; be able to interpret data, identify trends, and make suggestions for improvements