[Hiring] Quality Auditor REMOTE USA
Position: Quality Auditor
Date Posted: June 7, 2026
Industry: Healthcare / Health Insurance / Claims Administration
Employment Type: Full Time (Remote – US)
Experience: 3 Years Experience in Health Plan Claims Auditing
Qualification: High School Diploma or GED (Required)
Salary: $35,000 – $48,000 per year
Location: United States, REMOTE
Company: HealthEdge
Description:
HealthEdge is seeking a detail-oriented Quality Auditor with experience in health plan claims administration. This role focuses on auditing claims processing activities, ensuring compliance with healthcare standards, and maintaining high-quality operational performance across teams.
The position involves reviewing transactions, identifying errors, and providing structured feedback to improve accuracy and efficiency within claims operations. The ideal candidate will also support training initiatives and ensure adherence to CMS guidelines and healthcare regulatory requirements.
Key Responsibilities:
• Audit transactions processed by health plan administration associates
• Ensure compliance with customer quality processes and audit procedures
• Share QA results with team members and management
• Identify errors and provide feedback for performance improvement
• Prepare and compile QA performance reports
• Support training teams with process improvement recommendations
• Participate in audit calibration activities
• Maintain knowledge of CMS claims processing rules and regulations
Requirements:
• High School Diploma or GED required
• Minimum 3 years of health plan claims auditing experience
• Medicare claims auditing experience preferred
• Proficiency in MS Excel, PowerPoint, and Outlook
• Familiarity with HealthRules Payor or Guiding Care (preferred)
• Strong analytical skills and ability to evaluate SLAs and KPIs
• Ability to work effectively in remote teams
Strong knowledge of:
• Health insurance claims auditing processes
• CMS regulations and Medicare Advantage guidelines
• Healthcare quality assurance standards
• SLA/KPI analysis and reporting
• Claims processing systems and tools
Disclaimer: The job details above are structured for clarity and based on publicly available content from recruiters/Company pages. All rights remain with the original source; names may be withheld for confidentiality. We are not involved in the hiring process.
