Claims Quality Auditor jobs in Pennsylvania

Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Quality Auditor
  • PCI Pharma Services
  • Philadelphia, PA FULL_TIME
  • Life changing therapies. Global impact. Bridge to thousands of biopharma companies and their patients.


    We are PCI.


    Our investment is in People who make an impact, drive progress and create a better tomorrow. Our strategy includes building teams across our global network to pioneer and shape the future of PCI.

    JOB SUMMARY:

    This position is responsible for providing the direction, organization, alignment, monitoring and cGMP compliance to ensure the successful, cost effective, timely and safe processing of customer orders. The position audits production room documentation, checks equipment challenges and hourly in-process inspections have been performed, ensures samples have been taken, and reviews room for 5S Compliance. These associates are responsible for performing real time batch record and documentation review during batch processing in order to drive improvements into our Right First Time (RFT) metrics. They are also responsible for leading and realizing continuous quality and process improvements on the production floor by mentoring, coaching and training their operational counterparts.

    ESSENTIAL DUTIES AND RESPONSIBILITIES :

    • Perform production room approvals after product and lot changes
    • Verifies first piece inspection to ensure finished goods code, format, and expiration date are correct
    • Ensure equipment is packaged within validated parameters and equipment calibration dates on all process equipment are within required specifications. If not, this individual will contact the appropriate personnel to recalibrate and/or remediate the issue.
    • Review batch record(MPI)to ensure equipment challenges and hourly inspections have been conducted and any non-conformances are addressed appropriately. Conduct periodic checks to confirm hourly inspections are being performed correctly and on track to meet AQL requirements.
    • Review sampling pages to ensure samples have been taken, labelled and documented appropriately
    • Audit production room to ensure Cleaning and Use logbooks, Mechanical Set-up logbooks, and Preventive Maintenance logbooks have been completed accurately and timely.
    • Confirm package (unit) functionality (perfs, peel, push, seals, etc.)
    • Check to ensure portable equipment has been cleaned and documented correctly on quality form.
    • Audit production personnel to ensure the job is performed safely including wearing required personal protective equipment.
    • Ensure recovery stations are segregated from product flow.
    • Confirm bulk material and components for job are correct and kept covered.
    • Review each equipment clean room logbooks for correct clean room, entries are complete, correct and legible.
    • Review temperature and humidity data to ensure within acceptable job parameters.
    • Document audits using the Quality Auditor checklist listing the room, production job description, and date when the audit was conducted.
    • Identify proactively gaps in batch records and PDR's to mitigate deviations and documentation errors.
    • Participate on improvement teams (i.e. FMEA's, Kaizen, batch record etc.) as needed.
    • Support Root Cause Analysis as needed.
    • Write quality event notifications for issues encountered on the production floor.
    • Ensure 5s Compliance.
    • This position may require overtime and/ or weekend work.
    • Must have knowledge of and adherence to all PCI, cGMP, and GCP policies, procedures and rules.
    • Must be dependable in work attendance.
    • May perform duties of Quality Coordinator.

    EDUCATION OR EQUIVALENT:

    • High School Diploma required
    • 2 - 4 years relevant experience in production, equipment and or process.
    • Packaging, Pharmaceutical, Bio-Pharmaceutical, and/or Medical Device background is preferred LANGUAGE SKILLS:
    • Must possess good analytical skills and excellent verbal and written communication skills.
    • Must demonstrate effective listening, coaching and interpersonal communications skills.

    KNOWLEDGE/SKILLSREQUIREMENTS:

    • Must be dependable and show initiative to improve safety, quality, throughput and cost performance.
    • Must be willing to work overtime and flexible in regards to working on all 3 shifts.
    • Able to balance multiple issues simultaneously in a fast paced environment.
    • Needs good problem solving skills, should be detail oriented and well organized.

    COMPUTER SKILLS:

    • Must be computer literate with past experience using MS Office, Lotus Notes, spreadsheets and ERP systems.

    PHYSICAL DEMANDS:

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be physically capable to perform the above duties with or without reasonable accommodations which may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand; walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision.

    WORK ENVIRONMENT:

    The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

    EQUAL OPPORTUNITY EMPLOYER/VET/DISABLED

    Join us and be part of building the bridge between life changing therapies and patients.


    LSNE is an EEO/AA Employer and all qualified applicants will receive consideration for employment without regard to, their race, color, religion, sex, age, national origin, ancestry, sexual orientation, gender identity, disability, protected genetic information, protected veteran status, military service, or other protected status. The Company’s EEO policy, as well as its affirmative action obligations, include the full and complete support of The Company.

     

  • 1 Month Ago

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Pharmacy Benefit Claims Auditor
  • TFG Partners
  • Pittsburgh, PA FULL_TIME
  • Full Time Pittsburgh This is an opportunity for a motivated individual who likes to work in a “can do” environment. Client commitments are the driving force of this company, which means that we’re loo...
  • 22 Days Ago

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Pharmacy Technician Auditor - Claims
  • Integrated Pharmacy Solutions
  • Philadelphia, PA FULL_TIME
  • We are looking for a Pharmacy Claims Auditor to perform a variety of pharmacy audit duties. To succeed in this role, you should be an exceptional communicator with an analytical mind, attention to det...
  • 1 Day Ago

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Part Time Night Auditor
  • Quality Inn and Suites
  • Williamsport, PA PART_TIME
  • ```Duties```- Greet and welcome guests upon arrival- Check-in and check-out guests efficiently and accurately- Provide excellent customer service and address guest inquiries and concerns- Handle guest...
  • 26 Days Ago

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Internal Quality Auditor
  • ZOLL LifeVest
  • Pittsburgh, PA FULL_TIME
  • Location: Pittsburgh, PA, United States of America Cardiac Management Solutions At ZOLL, we're passionate about improving patient outcomes and helping save lives. We provide innovative technologies th...
  • 17 Days Ago

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Quality Auditor (2nd shift)
  • PCI Pharma Services
  • Philadelphia, PA FULL_TIME
  • Life changing therapies. Global impact. Bridge to thousands of biopharma companies and their patients.We are PCI. Our investment is in People who make an impact, drive progress and create a better tom...
  • 19 Days Ago

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Quality Auditors
  • ResourceMFG
  • Columbus, GA
  • summary Looking for 1st shifters. Starting pay at $18 could change with more experience. Weekly pay/health benefits. CNC...
  • 4/25/2024 12:00:00 AM

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Quality Auditor
  • LHH
  • LHH Recruitment Solutions is seeking a Quality Auditor in Birmingham, Alabama. The ideal candidate will conduct audits, ...
  • 4/24/2024 12:00:00 AM

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Quality Auditor
  • Transform Automotive
  • Utica, MI
  • Job Description Job Description ABOUT THE ROLEMeans TransForm Products is now the newest business unit of the Amsted Aut...
  • 4/24/2024 12:00:00 AM

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Quality Auditor
  • ResourceMFG
  • Columbus, GA
  • summary ResourceMFG is now hiring Quality Auditors in Lafayette! Pay and Hours: 1st Shift: 4am-12:30pm-$20/hr 2nd Shift:...
  • 4/23/2024 12:00:00 AM

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Quality Auditor
  • THE CARLSTAR GROUP LLC
  • Slinger, WI
  • Job Details Job Location Slinger WI - Slinger, WI Position Type Full Time Education Level High School Diploma or Equival...
  • 4/23/2024 12:00:00 AM

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Quality Auditor
  • Systems Inc.
  • Malvern, AR
  • We are System s, LLCa lead ing manufacturer and design er of loading dock equipment . We continue to GROW and are seekin...
  • 4/23/2024 12:00:00 AM

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Quality Auditor
  • Johnson Controls
  • Louisville, KY
  • Overall Responsibilities: This position is responsible for ensuring that quality data sheets are collected and documente...
  • 4/22/2024 12:00:00 AM

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Quality Auditor
  • H&H
  • Annapolis, MD
  • Description We are offering an exciting opportunity for a Quality Auditor in our Annapolis, MD office. The Quality Audit...
  • 4/21/2024 12:00:00 AM

Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east. Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Auditor jobs
$45,887 to $56,243

Claims Quality Auditor in Bloomington, IN
Evaluates claims activities of other departments and / or companies.
December 05, 2019