A Little More About this Role: We’re looking for a Claims Quality Auditor. This role will ensure the accurate and correct processing of medical claims, based on contractual obligations and regulatory requirements. The Claims Quality Auditor is tenacious in supporting Gravie’s ability to process claims correctly, the first time. This entails finding potential trouble spots, identifying root cause and shutting down all gaps and process adherence issues to prevent those trouble spots from persisting. You will: Conduct pre-payment, post-payment, and auto-adjudication audits, including routine to moderately complex claims that cover multiple benefit plan designs. Ensure processing, payment, and financial accuracy of claims by verifying all aspects have been handled correctly according to SPDs, regulatory requirements, and standard operating procedures. Meticulously track and report audit results, including finalized decisions for use in reporting and trending analysis. Responsible for identifying corrections and/or adjustments needed, and to verify corrections and/or adjustments are completed and accurate. Identify and escalate trends based on quality reviews for root cause solutioning,... Click Apply to read the full job description.