[Hiring] QA Auditor II REMOTE USA
Position: QA Auditor II
Date Posted: December 27, 2025
Industry: Healthcare / Finance / Quality Assurance
Employment Type: Full Time
Experience: Audit experience with financial processes; experience in healthcare claims auditing preferred
Qualification: Associate degree from an accredited institution (Bachelor’s preferred)
Salary: $51,000 – $80,070
Location: Texas, United States REMOTE
Company: Healthfirst
Description:
Healthfirst is seeking a detail-oriented and experienced QA Auditor II to join our remote team. This role involves performing Quality Assurance audits of financial processes handled by internal staff and outsourced vendors to ensure adherence to policies, procedures, and quality standards, while mitigating financial risk. The QA Auditor II will investigate, audit, conduct root cause analysis, handle determinations, and track/trend findings with minimal supervision.
Key Responsibilities:
• Conduct moderately complex to complex quality audits of provider claims, including high-dollar and specialized claims across multiple lines of business
• Audit work of junior auditors and identify coaching/training opportunities
• Identify and communicate audit findings with actionable recommendations for business operations
• Assist management with preparation of departmental reports, policies, and procedures
• Mentor and coach Financial and/or Operations QA auditors
• Serve as a Subject Matter Expert on process improvement projects
• Participate in User Acceptance Testing (UAT) for system enhancements or corporate projects
• Analyze errors to determine root causes and appropriate classifications
• Record and track quality assessment scores; provide feedback to improve processes and performance
• Review and investigate claims for medical, facility, pharmacy, dental, and vision services according to Healthfirst policies and contracts
• Prepare investigation reports and present findings to senior staff
• Handle specific claims and appeals, including processing, tracking, documenting, reporting, and disseminating recommendations
• Review and evaluate the accuracy and effectiveness of existing training materials
Minimum Qualifications:
• Audit experience in investigation, determination, and reporting of financial processes
• Proficiency in Microsoft Office, including advanced Excel, Word, and PowerPoint
• Experience conducting root cause analysis and analytical problem-solving
• Strong written and verbal communication skills; professional and clear
• Experience handling confidential information
• Associate degree from an accredited institution
Preferred Qualifications:
• Bachelor’s degree from an accredited institution
• Healthcare claims adjudication and processing experience
• Ability to handle increasing workload and responsibilities
• Eagerness to learn and evaluate new technical and procedural information
• ICD10 certification
• Basic knowledge of SQL, Tableau, and SharePoint
• Knowledge of multiple lines of business (e.g., NY Medicare, Medicaid, Family Health Plus, Child Health Plus)
Hiring Range:
• Greater New York City Area (NY, NJ, CT residents): $58,900 – $80,070
• All Other Locations (within approved locations): $51,000 – $74,880
Healthfirst provides a competitive compensation and benefits package, including medical, dental, and vision coverage, incentive programs, life insurance, and 401k contributions, subject to eligibility requirements.
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