Quality Review Auditor

Salary Range: $80,000 - $115,000

Job Posting End Date: June 27th 2025

 

We’ve Got You Under Our Wing

We are the duck. We develop and empower our people, cultivate relationships, give back to our community, and celebrate every success along the way. We do it all…The Aflac Way.

 

Aflac, a Fortune 500 company, is an industry leader in voluntary insurance products that pay cash directly to policyholders and one of America's best-known brands. Aflac has been recognized as Fortune’s 50 Best Workplaces for Diversity and as one of World’s Most Ethical Companies by Ethisphere.com.

 

Our business is about being there for people in need. So, ask yourself, are you the duck? If so, there’s a home, and a flourishing career for you at Aflac.

 

 

Worker Designation – This role is a remote role. This means you will be expected to work from your home, within the continental US. If the role is remote, there may be occasions that you are requested to come to the office based on business need. Any requests to come to the office would be communicated with you in advance.

 

What does it take to be successful at Aflac?

• Acting with Integrity
• Communicating Effectively
• Pursuing Self-Development
• Serving Customers
• Supporting Change
• Supporting Organizational Goals
• Working with Diverse Populations

 

What does it take to be successful in this role?

• Attention to detail and a strong grasp of clinical and/or vocational, ADA decision frameworks.

 

• Clear and professional written communication skills for feedback documentation.

 

• Comfortable working with audit tools, tracking outcomes and utilizing tech platforms.

 

• Strong organizational and time management skills with the ability to manage multiple audits and deadlines.

 

• Ability to work independently while adhering to standardized audit procedures.

 

Education & Experience Required

• Bachelor's Degree Nursing, Business, Healthcare or related filed
• 3 or more years of experience performing assessment/reviews in a related field.
• Active clinical license RN, or professional vocational certification (role specific, clinical or VRC).
• Active clinical license e.g., LCSW, LMHC, LPC, or equivalent clinical license.

Or an equivalent combination of education and experience

 

Education & Experience Preferred

• Master's Degree Nursing, Business, Healthcare or related filed
• Certifications - CRC, CDMS, CCM, (role specific)
• 3 or more years of experience in disability management industry.
• Utilization review experience and/or experience using specific medical, behavioral health, vocational rehab, ADA criteria or protocols. (role specific)

 

Travel

Less than or equal to 10%

 

Principal Duties & Responsibilities

• Perform internal audits of reviews and/or deliverables to evaluate adherence to criteria, internal policies, and documentation standards.

 

• Review documentation for completeness, clarity, and alignment with established protocols and approved guidelines.

 

• Use standardized audit tools and scorecards to ensure consistent assessment of reviewer performance.

 

• Document audit findings and provide targeted, constructive feedback to reviewers.

 

• Collaborate with leadership to track audit outcomes and identify recurring issues or trends in reviewer performance.

 

• Participate in calibration sessions and inter-rater reliability checks to ensure audit consistency.

 

• Support training and coaching efforts by flagging opportunities for additional education or process improvement.

 

• Assist in maintaining audit documentation and records in accordance with organizational policies.