Quality Assurance Partner

Status: Non Exempt

Why this role is important:

Our clients and members count on us to process claims quickly and accurately. How do we do that? By delivering excellent service with only the highest quality of work. Conducting Aither’s quality assurance audits of work performed will ensure that we continue "Being Aither."

What you’ll do:

• Learn and understand claim processes and work flows.

• The Quality Assurance Partner will conduct daily audits of processed claims and assist with other program audits as deemed appropriate by the department manager.

• Assist in the development and implementation of auditing and monitoring mechanisms.

• Review processed claims with accuracy.

• Maintain consistent quality and production standards, by providing feedback from audits and identifying training needs.

• Assist with other ancillary department tasks as necessary, including processing claims.

• Complete special projects as assigned.

• Investigate and research issues as required.

• Act as a subject matter expert.

• Prepare and provide statistics related to individual and department performance.

What you’ll bring:

• High School Diploma or GED.

• Minimum of five (5) years experience as a claims examiner or auditor with self-funded health care plans and processing in a TPA environment.

• Talent for communicating clearly.

• Problem solving skills.

• Strong analytical, organizational, and interpersonal skills, with the ability to communicate with members of the team effectively.

• PC, EXCEL and Windows experience. 

• Ability to collect data and draw valid conclusions.

• Ability to prioritize.

• A precise attention to detail.

• Strong ability to focus on a task and ensure accuracy.

• Ability to maintain confidentiality.

• The motivation to learn and constantly improve processes.

• Mindset of a team-player - you'll be ready to jump in and help on any Aither task

You might also bring:

• Associates Degree

• Bachelors Degree

Compensation Range: $21/hr-$30/hr

Actual starting pay within this range will be determined based on several factors, including relevant experience, healthcare or TPA industry knowledge, skills, and overall qualifications. Final compensation will also take into account internal equity and market factors. 

 As an Equal Opportunity / Affirmative Action Employer, Aither Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Aither Health will not tolerate discrimination or harassment based on any of these characteristics. Aither Health encourages applicants of all ages.