Funding Quality Assurance Auditor

POSITION SUMMARY

The Funding Quality Assurance (QA) Auditor supports the Funding Department by performing detailed audits, ensuring accuracy, and maintaining compliance across all funding related processes. This role is responsible for reviewing daily operational outputs, identifying discrepancies, and helping maintain a high standard of data integrity. As the department’s audit program expands, the QA Specialist will take on additional audit responsibilities, including more complex funding and reimbursement workflows.

ESSENTIAL FUNCTIONS

* Audit Daily ACH Files: Review and validate daily ACH files to ensure accuracy, completeness, and alignment with internal and client requirements. * Monitor Undelivered Emails: Track undelivered or bounced funding related emails, determine root causes, and ensure proper resolution. * Email Assignment and Routing: Review incoming funding inbox emails and accurately assign them to the appropriate Funding Coordinator based on content, client, and workflow type. * Stop Loss Reimbursement Audits: Audit stop loss reimbursement applications, ensuring documentation accuracy, correct calculations, and adherence to carrier and internal guidelines. * Additional Funding Process Audits: Participate in the development and execution of new audit procedures as the department grows, including but not limited to: + Funding request accuracy + Refund processes + Client specific funding workflows + Compliance driven audit initiatives * Process Improvement Support: Identify trends, recurring issues, and opportunities for process improvement. Collaborate with leadership to refine workflows and strengthen internal controls. * Other duties as assigned

EDUCATION

* Bachelor's degree or equivalent work experience required.

EXPERIENCE AND SKILLS

* 3+ years’ experience in health insurance, TPA operations, or a related financial/administrative field required; background in funding, claims, stop loss, or financial auditing strongly...