Junior Compliance Specialist
Akinox
Support compliance, information security, and governance at Akinox, a Canadian digital health company. Coordinate audits, risk management, ISO certifications, and privacy activities.
Open
Sutherland helps organizations modernize how they operate and serve their customers through digital transformation and business process outsourcing. Its work combines artificial intelligence, automation, cloud engineering, digital customer experience, and enterprise technology solutions, with applications across sectors including healthcare, insurance, travel, banking, and telecommunications. The company’s teams focus on improving critical business processes, creating more responsive customer interactions, and helping clients adapt through technology-enabled operations. For job seekers, Sutherland offers a range of career paths connected to digital services, customer experience, technology delivery, and intelligent automation.
Senior Associate Health Claims Quality Auditor (Remote, New Jersey)
Review U.S. healthcare claims, including high-dollar billing, to find errors and potential fraud risks. Help improve claim quality and processes at Sutherland.
Description
- Monitor performance and service quality to support customer satisfaction.
- Communicate with clients and team members to understand needs, resolve issues, and meet expectations.
- Share key information through timely, accurate reports.
- Develop strategies using data, analysis, and observations.
- Review healthcare claims for billing errors, discrepancies, and potential fraud.
- Contribute to process documentation and quality improvement efforts.
Requirements
- Experience with U.S. healthcare and commercial and/or Medicaid claims processing.
- Extensive experience handling high-dollar claims.
- Knowledge of standard claim forms, including CMS-1500 and UB-04.
- At least 2 to 3 years of direct experience in medical claims processing, medical billing, or healthcare auditing.
- Ability to spot billing errors, discrepancies, and potential fraud.
- Strong written and spoken communication skills.
- Expert knowledge of complex commercial payer contracts, reimbursement methods, and federal Medicare and Medicaid regulations.
- Experience documenting processes.
- Proficiency with Microsoft Office.
- Ability to work in a fast-paced environment.
- Able to build trust and professional rapport with colleagues and contribute as a team member.
- Strong analytical skills, including interpreting data, identifying trends, and recommending improvements.
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