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Quality Reviewer-Medical Claims Process Mon- Fri 8am- 5 pm($15-16/hr)

MultiPlan Irving Full-Time
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Are you looking for a rewarding new position with an industry leader with a firm commitment to its employees? Join our team at MultiPlan! Founded in 1980, we are the industry's most comprehensive provider of healthcare cost management solutions. We have almost 1,000,000 healthcare providers under contract, an estimated 68 million consumers accessing our network products, and 40 million claims reduced through our network and non-network solutions each year.
JOB SUMMARY: This position is responsible for phone and process audits across the department and conducts daily audits of work performed in assigned operational areas.


1. Perform daily phone and process audits and follow standard processes and procedures for more complex positions as assigned.

2. Identify recurring issues for review. Make recommendations on less complex issues and escalate more complex issues

3. Display an indepth understanding of multiple review processes and work flows.which may vary

4. Perform daily specified system processes from queue or on delivered reporting

5. Maintain consistent quality and production standards.

6. Mentor less experienced team members

7. Participate in special projects (recurring or initiatives) as assigned.

8. Maintain an understanding of and consistely display the ability to objectively think about goals and the intent of any assigned project.

9. Collaborate, coordinate, and communicate across disciplines and departments.

10. Ensure compliance with HIPAA regulations and requirements.

11. Demonstrate Company's Core Competencies and values held within.

12. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.


This job works under general supervision to complete job responsibilities. The incumbent possesses and applies a range of knowledge gained through experience to complete the job responsibilities. One uses established guidelines and experience to resolve routine and sometimes complex issues and refers more complex issues to higher levels. Independent judgment is required to accomplish daily tasks and duties.
* Minimum HS Diploma (or GED)

* Minimum 2 years of industry related experience

* Required licensures, professional certifications, and/or Board certifications as applicable

* Quality assurance experience preferred

* Knowledge of insurance or healthcare industry

* Knowledge of claim payment and process preferred

* Communication (written, verbal and listening), interpersonal, time management, project and analytic skills

* Ability to understand methodology for multiple positions in order to identify issues.

* Ability to maintain consistent quality and production standards

* Ability to use software, hardware and peripherals related to job responsibilities including MS Office Suites, Word, Excel, Outlook, etc.

* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

As a Medical Quality Assurance Auditor with MultiPlan, you will be part of an organization with a proud 30-year legacy of experience and growth. We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:
* Medical, dental, and vision coverage
* Life insurance
* Optional and dependent life insurance
* Short- and long-term disability
* 401(k) employer matching
* Paid time off (earn 20 days per year)
* Paid company holidays
* Floating holiday
* Tuition reimbursement
* Flexible Spending Account
* Employee Assistance Program

Summer hours = Memorial Day to Labor day we get off two hours early EVERY FRIDAY!!

Opportunity. Recognition. Satisfaction. Grow your career with MultiPlan!


As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.

Recommended skills

Microsoft Excel
Health Care
Microsoft Outlook
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