Senior Quality Auditor (Healthcare)

Location: Remote within the continental United States; preferred working hours align with Central or Eastern Standard Time.

Pay range: $23.23–$39.61 per hour.

Company

hirify.global provides healthcare services and works to improve access to effective care for individuals, families, and communities.

What you will do

• Audit and validate routine pre- and post-payment medical claims for accurate adjudication and policy compliance.
• Audit provider data loaded into claims-processing systems and identify data-related discrepancies.
• Research reviewed claims and enrollment issues to determine causes and appropriate resolutions.
• Document audit results, summarize findings and recommendations, and report them to management.
• Communicate audit results to claims departments to improve processing and resolution quality.
• Provide qualified data for training programs, policies, and procedures.

Requirements

• Must be authorized to work in the United States without employment-based visa sponsorship.
• High school diploma or equivalent.
• Four years of general data management experience in automated claims processing, claims research, or provider maintenance.
• Working knowledge of health insurance products, policies, procedures, contract and benefit plan coding, and applicable regulatory and certification standards.
• Some college coursework is preferred.

Culture & Benefits

• Remote work with flexibility in the work arrangement.
• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Work focused on improving healthcare access and outcomes.