Your Role

The Medi-Cal Claims Operations team is responsible for ensuring claims are processed accurately and timely. The Quality Assurance Auditor, Advanced will report to the Medi-Cal Operations Manager. In this role you will be responsible for performing audits that are routine in nature for the Medi-Cal line of business for all claim types.

Your Work

In this role, you will:

• Be responsible for performing audits that are routine in nature where limited judgment is required.
• Focus on single area of expertise or line of business (Claims, Inquiry, Enrollment); objectively review and interpret standards, procedural documentation and contract and legal verbiage.
• Identify and document audit observations and findings.
• Notify Supervisor when communications with operations are necessary; coordinate appropriate messaging. 
• Identify and resolve routine problems independently; escalate issues with Supervisor as appropriate.
• Ability to objectively review and interpret standards, procedural documentation, contracts and legal verbiage.
• Identifies and documents audit observations and findings.
• Ability to problem solve as some issues may require some analysis to understand and resolve. 
• Responsible for providing guidance, coaching, and training to other employees within job area.