ZipRecruiter

Log In

Caliber Smart
Caliber Smart

60 Caliber Quality Control Auditor Jobs Hiring Near You

OC Staffing and HR Solutions

Be Seen First

Quality Control Auditor

Los Angeles, CA · On-site

$21/hr

Position Summary The Quality Control Auditor is responsible for inspecting imported production once it arrives at the domestic office. This role ensures all garments meet company quality standards ...

OC Staffing and HR Solutions

Be Seen First

Quality Control Auditor

Los Angeles, CA · On-site

$21/hr

Position Summary The Quality Control Auditor is responsible for inspecting imported production once it arrives at the domestic office. This role ensures all garments meet company quality standards ...

TiltEdge Solutions LLC

QC Auditor

Millville, NJ · On-site

Position: QC Auditor Work Location: Millville, NJ 08332 Payrate: $23.61/hr Duration: 3+ Months role with high chances of extension/conversion Shift: Wednesday to Thursday 3:00pm - 11:00pm Friday - 7 ...

Arc Home LLC

Quality Control Auditor (Mortgage)

$27 - $43/hr

Arc Home is excited to add a Quality Control Auditor to our team to work standard business hours in the time zone in which you live within the US. Wholesale and/or Non-delegated Correspondent ...

Ahresty Wilmington Corporation

Auditor

Wilmington, OH · On-site

The QC Auditor is responsible for following work instructions, and inspection standards as directed by QC leadership. QC Auditor is responsible for acting in the best interest of quality of the parts ...

Ahresty Wilmington Corporation

Auditor

Wilmington, OH · On-site

The QC Auditor is responsible for following work instructions, and inspection standards as directed by QC leadership. QC Auditor is responsible for acting in the best interest of quality of the parts ...

DR Horton, Inc.

Special Projects QC Auditor

Austin, TX · On-site

Horton, Inc. is currently looking for a Special Projects Quality Control Auditor for their Financial Services Quality Control Department. The right candidate will provide support to the Quality ...

Dollar Tree

QC Auditor

Litchfield Park, AZ · On-site

Developing and utilizing industry-standard inventory control methods, such as just-in-time (JIT) or first-in, first-out (FIFO) approaches * Ensure all items in the warehouse are appropriately ...

ADVICS

Quality Control Auditor

Lebanon, OH · On-site

Promotes teamwork and Company policies within the Q.C. department, and on the manufacturing floor. QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform ...

Dollartree

QC Auditor

Litchfield Park, AZ · On-site

Developing and utilizing industry-standard inventory control methods, such as just-in-time (JIT) or first-in, first-out (FIFO) approaches * Ensure all items in the warehouse are appropriately ...

next page

Showing results 1-20

All JobsCaliber JobsCaliber Quality Control Auditor Jobs

Caliber Smart Jobs Information

What other companies are hiring for Quality Control Auditor jobs?
What are the most popular jobs at Caliber?

Quality Control Auditor

LSMA Management Inc

San Bernardino, CA

$28.85 - $33.65/hr

Other

Posted 12 days ago

Job description

Description

JOB SUMMARY


The Quality Control Auditor - Claims Management is responsible for performing detailed audits of claims processing activities to ensure accuracy, regulatory compliance, and adherence to contractual, coding, and reimbursement requirements within the Managed Services Organization (MSO). This role evaluates claims adjudication performed by Claims Examiners, identifies errors, analyzes trends, and provides recommendations to improve claims accuracy, operational efficiency, and compliance with federal and California regulatory standards.

The Quality Control Auditor supports delegated managed care compliance by auditing claims in accordance with health plan contracts, coding standards, reimbursement methodologies, and applicable regulatory requirements, including Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS), and Department of Health Care Services (DHCS) standards where applicable.

This role plays a critical role in maintaining claims processing integrity, minimizing financial risk, ensuring regulatory compliance, and supporting continuous operational improvement.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS


Education/Training

Minimum: High School Diploma or equivalent.

Preferred: Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Compliance, or related field.

Experience 

Minimum: At least five years of managed care claims auditing, claims examiner, or claims quality control experience. Two years of experience as a Claims   Examiner or Claims Adjuster. 

Preferred: Experience in MSO, IPA, or health plan environment. Experience supporting delegated managed care and regulatory audits. Experience auditing   professional and institutional claims.

Certification(s)

Preferred: Certified Professional Coder (CPC), Certified   Professional Medical Auditor (CPMA), or Certified Professional Compliance Officer (CPCO)


Skills, Knowledge & Abilities

Strong knowledge of managed care claims processing and audit methodologies.

Knowledge of CPT, HCPCS, ICD-10, DRG, and reimbursement methodologies. 

Knowledge of health plan contracts, fee schedules, and DOFR agreements. 

Knowledge of DMHC, CMS, DHCS, and regulatory requirements.

Strong analytical and problem-solving skills.

Ability to interpret and apply complex regulatory and contractual requirements.

Strong attention to detail and audit documentation skills.

Excellent written and verbal communication skills. 

Proficiency with claims systems such as EZ Cap and Microsoft Office applications. 

Ability to work independently and meet audit   deadlines.

Ability to maintain confidentiality and data integrity.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or hybrid office environment and involves prolonged periods of sitting, computer use, and document review. The role requires sustained concentration, analytical thinking, and attention to detail to ensure claims accuracy and regulatory compliance. Light physical effort may be required, including lifting up to approximately 10 pounds and occasional bending, reaching, or filing. This role requires the ability to maintain confidentiality and professionalism when handling sensitive claims and compliance information.


PAY RANGE

$28.85 - $33.65 / hourly

Apply