Healthfirst · 1 day ago
QA Auditor, Quality Assurance - Remote
United States
Full-time
Remote
New Grad, Entry Level
$59K/yr - $80K/yrHealthfirst is a healthcare organization, and they are seeking a Quality Assurance Auditor responsible for performing internal quality audits of operational processes. The role involves investigating, auditing, and ensuring compliance with policies and quality standards while working under minimal supervision.
Commercial InsuranceHealth CareHealth InsuranceInsurance
Responsibilities
Conduct quality audits of A&G items including grievances, pre-service appeals, and post service appeals utilizing appropriate sources of information; including eligibility, claims, authorizations, service forms, faxes, and any additional information required to complete the request. Analyze errors and determine root causes for appropriate classification, trending, and remediation
Record/track quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure quality
Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and fully resolved in a compliant manner
Present results of investigations to senior staff and prepare written reports concerning investigation activities
Subsequent auditing and handling of specific appeal and grievance requests including processing where applicable, tracking, documenting, reporting and dispersal of findings and recommendations
Identify defects and improve departmental performance by supporting quality, operational efficiency and production goals
Assist in the development of departmental policies and procedures; reviews the efficiency of existing training
Meet established time frames and rates of performance for the quality and quantity of work for the position
Participate in regulatory and mock audit activities including universe review, universe scrubbing, risk analysis, timeliness assessment, and case walkthrough activities
Additional duties as assigned
Qualification
Required
Experience with the investigation, resolution, and reporting of appeal and grievance processes
Experience in Microsoft Office suite of applications including Excel (formatting formulas, managing data, and filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations)
High School Diploma or GED from an accredited institution
Preferred
Associate degree from an accredited institution
ICD10 certification
Experience in an Auditing capacity conducting root cause analysis
Knowledge of at least two or more lines of business such as Medicare NY/NJ, Medicaid, Family Health Plus, Child Health Plus, NH Family
Experience handling confidential information
Compliance & Regulatory Responsibilities: Knowledge of state and federal appeal and grievance regulatory requirements
Benefits
Medical
Dental and vision coverage
Incentive and recognition programs
Life insurance
401k contributions
Company
Healthfirst
Healthfirst is a health insurer providing medical, business, and health insurance services.
Founded in 1993
1001-5000 employees
H1B Sponsorship
Healthfirst has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (35)
2024 (26)
2023 (19)
2022 (31)
2021 (3)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Pat Wang
President and CEO
Recent News
2025-10-10
Crain's New York Business
2025-09-23
2025-08-21
Company data provided by crunchbase