Senior Associate – Health Claims Quality Auditor

🔥 17 hours ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏰ Full Time

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Sutherland

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1986

🏥 Healthcare

🛡️ Insurance

✈️ Travel

💰 $300M Secondary Market on 2014-10

Healthcare • Insurance • Travel

Sutherland is a global company specializing in digital transformation and business process outsourcing services. They leverage advanced technologies such as Artificial Intelligence, automation, and cloud engineering to drive digital performance and optimize critical business operations. Sutherland offers a variety of services including digital CX, enterprise technology solutions, and intelligent automation across multiple industries such as banking, healthcare, and telecommunications. Their focus is on delivering measurable outcomes, enhancing customer experiences, and enabling business agility through innovative digital solutions.

📋 Description

• Oversee and manage performance and service quality to guarantee customer satisfaction • Establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations • Relay important information through timely and accurate reports • Produce effective strategies based on data reports, analysis, and observations • Audit healthcare claims and identify billing errors, discrepancies, or potential fraud • Support process documentation and quality improvement initiatives

🎯 Requirements

• Experience in US Healthcare and knowledge in handling commercial and/or Medicaid claims processes • Extensive experience handling high-dollar claims • 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 identify minor billing errors, discrepancies, or potential fraud • Strong written and verbal communication skills • 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 • Proactive ability to develop trust and professional rapport with employees and team members; team-player approach • Strong analytical skills; ability to interpret data, identify trends, and suggest improvements