Healthcare Quality Auditor – Provider Services

About the role

The Healthcare Quality Auditor – Provider Services ensures that all provider‑service interactions are accurate, compliant, and consistently delivered. Working onsite in Makati with the possibility of remote work after training, the role supports quality assurance across eligibility, claims, payments, appeals, and other provider‑facing workflows.

Key responsibilities

• Perform assigned quality audits on provider‑service interactions, claims‑related transactions, and documentation, meeting volume, sampling, quality, and turnaround‑time targets.
• Take production calls when required and achieve the expected production cadence.
• Apply approved QA scorecards, audit forms, SOPs, and scoring guidelines objectively.
• Validate data accuracy, policy compliance, financial impact, documentation quality, and timely resolution.
• Audit inquiries across phone, email, fax, web, and other channels, ensuring proper use of resources and workflows.
• Identify critical errors, repeat issues, compliance risks, and documentation gaps for immediate escalation.
• Maintain accurate audit records in the designated QA platform and meet established timelines.

Required profile

• Ability to complete audits accurately and within set deadlines.
• Strong attention to detail for data, policy, and documentation review.
• Capability to work collaboratively with Operations, Team Leaders, Training, Workforce Management, and Compliance teams.
• Willingness to follow approved resources, workflows, and documentation standards.

Required skills