Healthcare Quality Auditor | Provider Services

Location: Valero, Makati City, Metro Manila, Philippines. Onsite during training and operationally as required; remote or hybrid work may become available based on sustained performance, business, client, security, and technology requirements. Shifting graveyard schedule, including nights, weekends, and holidays.

Company

hirify.global provides back-office support technology, claims processing, digital transformation, and outsourced healthcare operations for health plans.

What you will do

• Audit provider-service calls, emails, faxes, web inquiries, claims transactions, and documentation against approved QA scorecards and client requirements.
• Evaluate accuracy, policy adherence, financial and claims impact, compliance, documentation quality, call handling, and timely resolution.
• Identify critical errors, repeat errors, compliance risks, process gaps, and provider-experience concerns, escalating urgent issues appropriately.
• Participate in internal and client calibrations, Audit the Auditor reviews, and side-by-side scoring sessions.
• Provide evidence-based feedback, support dispute reviews, conduct root-cause analysis, and recommend corrective actions or training.
• Track audit KPIs, prepare quality reports, analyze error trends, and support training, certification, and process improvements.

Requirements

• High school diploma or equivalent required; college education is preferred.
• 4–5 years of experience in a healthcare contact center, provider services, claims support, claims processing, quality assurance, or a comparable healthcare operations environment.
• 2–3 years of experience as a Quality Auditor, QA Analyst, or SME.
• Working knowledge of healthcare claims, EOBs, appeals, eligibility, benefits, payment processes, provider-service workflows, documentation standards, and contact-center operations.
• Strong analytical, problem-solving, communication, organizational, decision-making, confidentiality, compliance, and attention-to-detail skills.
• Ability to meet audit volume, accuracy, calibration, reporting, attendance, schedule, and production requirements; proficiency with Microsoft Office and online systems.

Nice to have

• Experience with Monday.com, AWS Connect, QA platforms, call-recording tools, claims systems, workforce tools, or performance dashboards.
• Relevant post-secondary education.

Culture & Benefits

• Zero Error Mindset focused on quality, compliance, consistency, and provider experience.
• Comprehensive medical and dental HMO coverage.
• HMO coverage from Day 1, including one dependent.
• Remote or hybrid eligibility may be granted after training or during later operational stages, subject to performance and business requirements.