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Senior Associate – Health Claims Quality Auditor
Sutherland. Oversee and manage performance and service quality to guarantee customer satisfaction .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims processing, including knowledge of CMS-1500 and UB-04 forms, while effectively managing client communication and ensuring service quality. Proficient in analyzing data to identify trends and improve processes within the US healthcare system.
Highest-signal resume keywords
Medical Claims ProcessingHealthcare AuditingCMS-1500 and UB-04 FormsAnalytical SkillsCommunication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical BillingHigh-Dollar Claims HandlingData AnalysisBilling Error IdentificationProcess Documentation
Soft Skills
Team PlayerProactive CommunicationTrust Building
Tools & Technologies
MS Office
Industry Keywords
US HealthcareCommercial ClaimsMedicaid ClaimsPayer ContractsReimbursement MethodologiesMedicare Regulations
About the role
Key responsibilities & impact- Oversee and manage performance and service quality to guarantee customer satisfaction
- Establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations
- Relay important information through timely and accurate reports
- Produce effective strategies based on data reports, analysis, and observations
- Audit healthcare claims and identify billing errors, discrepancies, or potential fraud
- Support process documentation and quality improvement initiatives
Requirements
What you’ll need- Experience in US Healthcare and knowledge in handling commercial and/or Medicaid claims processes
- Extensive experience handling high-dollar claims
- Understanding of standard claim forms such as CMS-1500 and UB-04
- Minimum of 2 to 3 years of direct experience in medical claims processing, medical billing, or healthcare auditing
- Ability to identify minor billing errors, discrepancies, or potential fraud
- Strong written and verbal communication skills
- Expert knowledge of complex commercial payer contracts, reimbursement methodologies, and federal Medicare/Medicaid regulations
- Experience with process documentation
- Ability to work in MS Office
- Ability to work in a fast-paced environment
- Proactive ability to develop trust and professional rapport with employees and team members; team-player approach
- Strong analytical skills; ability to interpret data, identify trends, and suggest improvements