Healthcare Quality Auditor | Provider Services
HybridMakati City, Metro Manila, Philippines or Makati, Cagayan Valley, Republic of the Philippines
Job Summary
Conduct quality audits for provider-service interactions, claims transactions, and documentation to ensure accuracy, compliance, and consistent provider experience. Apply approved QA rubrics and scorecards to review eligibility, appeals, EOBs, and dispute resolutions while identifying error trends and critical risks. Participate in calibration sessions and audit-the-auditor reviews to maintain scoring alignment, then provide actionable feedback to frontline teams and support root-cause analysis for recurring issues. Track daily audit volumes and prepare reports on quality scores, error categories, and coaching completion to drive performance improvements. Work graveyard or shifting hours onsite in Valaki, Makati City, with eligibility for WFH after training. Model 100% quality standards on any production work completed.
Required Qualifications
- High school diploma or equivalent
- College degree or relevant post-secondary education preferred
- At least 4 to 5 years of experience in a healthcare contact center, provider services, claims support, claims processing, quality assurance, or comparable healthcare operations environment
- Prior experience of 2-3 years as a Quality Auditor, QA-Analyst, SME
- Working knowledge of healthcare claims, EOBs, appeals, eligibility, benefits, payment processes, provider-service workflows, documentation standards, and contact-center operations
- Demonstrated ability to interpret QA guidelines, identify errors, apply scoring criteria consistently, and provide clear rationale for audit findings
- Strong analytical, problem-solving, decision-making, organizational, verbal, and written communication skills
- Exceptional attention to detail and demonstrated commitment to quality, accuracy, compliance, confidentiality, and customer/provider experience
- Ability to work in a metric-driven environment and meet audit volume, audit quality, feedback timeliness, calibration, reporting, attendance, adherence, and compliance requirements
- Proficiency with Microsoft Office and online systems; ability to learn and navigate multiple healthcare, client, QA, reporting, workforce, and performance-management systems
- Ability to work flexible schedules, including nights, weekends, and holidays, based on client coverage and quality requirements
- Onsite presence during training, transition, new-hire nesting, team stabilization, client visits, performance-management activities, or other operational needs
Desired Qualifications
- Experience with Monday.com, AWS Connect, QA platforms, call-recording tools, claims systems, workforce tools, and performance dashboards
- College degree or relevant post-secondary education
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