Overview
Opportunities for you!
- Consecutively recognized as a top employer by Forbes, and in 2025 by Newsweek
- Free Continuing Education and certification
- Tuition reimbursement, education programs and scholarships
- Vacation time starts building on Day 1, and builds with your seniority
- Free money toward retirement with a 403(b) and matching contributions
- Great food options with on-demand ordering
- Free parking and electric charging
Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.
We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page.
Responsibilities
The Team Leader Claims Quality Assurance Auditor-Trainer leads training and quality assurance programs and provides technical leadership in evaluating health insurance claims processing for accuracy, consistency, timeliness, regulatory and contractual compliance, and adherence to organizational policies and procedures.
This role serves as a senior subject matter expert and resource for Claims Operations, providing guidance on complex claims processing issues, audit methodology, regulatory requirements, benefit interpretation, coding, reimbursement, system functionality, and quality standards. The position independently performs complex, targeted, and high-risk audits; identifies trends and systemic issues; conducts root cause analysis; and develops recommendations and corrective action strategies to improve claims accuracy and operational performance.
The Team Leader Claims Quality Assurance Auditor and Trainer plays a key role in maintaining financial integrity, regulatory compliance, operational excellence, and consistent claims processing while driving measurable improvements in quality, efficiency, and member and provider service.
Qualifications
Education
o High School Diploma, High School Equivalency (HSE), or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate required
o Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, Education, Nursing, or a related field preferred
Experience
o Minimum five (5) years of health plan claims processing experience required
o Minimum three (3) years of experience in claims quality assurance, auditing, training, employee development, or related claims operations experience preferred
o Demonstrated experience performing complex claims audits and identifying trends, root causes, and opportunities for corrective action
o Demonstrated experience providing technical guidance, coaching, mentoring, or lead-level support to claims or quality assurance staff
o Experience leading quality improvement initiatives, projects, process changes, or cross-functional operational initiatives preferred
o Experience with commercial, Medicare, Medicaid, and self-funded health plans preferred
o Experience with QNXT or other healthcare claims administration systems preferred
o Experience developing and delivering technical or operational training programs preferred
o Experience supporting regulatory audits, accreditation activities, compliance reviews, or external examinations preferred
Licenses and Certifications
o CPC - Certified Professional Coder preferred
o CCS - Certified Coding Specialist preferred
o CPMA - Certified Professional Medical Auditor preferred
o AHIP certification or other relevant healthcare certifications preferred
o Additional quality assurance, auditing, claims, or healthcare certifications preferred
