Senior Quality Auditor

Location: Remote within the continental United States; preferred schedule aligned with Central or Eastern Standard Time.

Pay range: $23.23–$39.61 per hour.

Company

hirify.global provides healthcare services and solutions focused on improving access to care for individuals, families, and communities.

What you will do

• Audit and validate routine pre- and post-payment medical claims for accurate adjudication and compliance.
• Audit provider data loaded into claims-processing systems and research related claims and enrollment discrepancies.
• Review medical claims for exceptions, cost-saving opportunities, and adherence to established requirements.
• Research audit issues, determine root causes, and recommend appropriate resolutions.
• Document findings, maintain quality-improvement statistics, and report results to management.
• Communicate audit results to claims teams and provide data for training, policies, and procedures.

Requirements

• High school diploma or equivalent.
• Four years of general data-management experience in automated claims processing, claims research, or provider maintenance.
• Working knowledge of provider files and their relationship to claims-processing systems.
• Knowledge of health insurance products, policies, procedures, contract and benefit plan coding, and applicable regulatory standards.
• Must be authorized to work in the United States without current or future employment-based visa sponsorship.

Culture & Benefits

• Remote work structure with flexibility based on business needs.
• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Work focused on improving healthcare accessibility and effectiveness.