Claims Quality Analyst

Job Summary

A company is looking for an Analyst, Claims Quality.

Key Responsibilities

• Audit claim data for Medicare Part D, Medicaid, and Exchange lines of business to validate their accuracy
• Assist with post-implementation monitoring to ensure adjudication-related fixes/enhancements are functioning as expected
• Collaborate with Technical Operations Business Analysts and Product Managers to manage process changes, including defining requirements and executing test plans

Required Qualifications

• Bachelor/Associate Degree in a business-related field or equivalent combined education and experience preferred
• 1 - 3 years of related work experience, preferably in pharmaceutical claims adjudication systems or health plan organizations
• Participation in and support for compliance program objectives
• Ability to interact cooperatively and respectfully with other employees