Quality Assurance Auditor
Accenture
Total years of experience :15 years, 7 Months
• Performs regular Quality audits based on accepted standards in sampling to ensure delivery is consistent and at part with client standards.
• Generates timely and accurate audit reports wherein daily, weekly and MTD scores are available on an associate, team and SOW level.
• Performs quality analysis and is capable of identifying root causes and can create relevant action items to improve and sustain performance.
• Collaborates with onshore auditors and SME to ensure that processes are aligned to current client business rules.
• Claims Processing
• Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnoses and procedures.
• Processes claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
• Follows adjudication policies and procedures to ensure proper payment of claims or pend the claims.