UST Looking for Quality Auditor at Aliso Viejo, CA  Full Time

Quality Auditor

Associate III – BPM

Who we are:

UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers – and better outcomes for our communities.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.

You Are:

UST HealthProof is looking for a highly energetic and collaborative Quality Auditor with 3 years of health plan claims administration operations experience. This role will report to the Lead Auditor or Quality Audit Manager. Candidate should have excellent written and verbal communication skills and ability to liaise with customers organizations and multiple stakeholders to be successful in this role. The QA performs audits of an assigned group of transactions (claims, enrollment, premium billing, paper claims and correspondence scanning) and will interact with the client audit team and operational managers daily to report on audit findings, which have an impact on production and quality. This role requires the ability to work both independently with limited supervision and collaboratively in a team environment.

The Opportunity:

• Perform audit of transactions processed by health plan administration associates for a specific customer.
• Be responsible for following the customer quality process and tools for audit and rebuttal process.
• Share QA results with individual associates, coordinate with operational Team Leads and managers to provide feedback to individuals, clearly identifying errors and opportunities of improvement.
• Collate, compile and reports both team and individual associates’ QA performance to management and individuals.
• Provide inputs to Training team and Team Leads for up-to-date written processing instruction/refresher training needs.
• Participate in UST HealthProof’s or the customers’ Audit the Auditor program.
• Participate in semi-annual or annual auditor calibration activities.
• Maintain currency on CMS claims processing rules and guidelines for Medicare Advantage organizations and ACA Exchange and Off Exchange lines of business.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What you need:

• High school or equivalent degree
• Excellent comprehension and communication skill (verbal and written)
• 3 years of applicable health plan claims operations experience with a preference for at least one year of Medicare Advantage claims processing experience.
• High proficiency in using MS Excel and PowerPoint
• Extreme attention to detail
• Good understanding and ability to analyze contractual SLAs and KPIs
• Excellent People skills – ability to provide feedback in a positive manner.
• The ability to adapt quickly to a fast-paced environment
• Excellent written and oral communication skills.
• Ability to collaborate with Customers teams and represent UST Global Educational Qualifications: Minimum of High School Diploma, but some college preferred.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $39,520-$47,840

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits.

What we believe:

We’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it’s those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do.

Humility:

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

Humanity:

Through business, we will better the lives of those less fortunate than ourselves.

Integrity:

We honor our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

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UST Global celebrates diversity and inclusion. We are an Equal Employment Opportunity employer. We welcome candidates to apply for employment from diverse backgrounds and believe your unique perspective adds to the richness of our company culture. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.