Claims Quality Assurance Inspector

Job Summary

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