Claims Quality Assurance Analyst

Job Summary

Working remotely in a full-time salaried capacity, the Claims Quality Assurance Analyst will conduct quality reviews of claims processes, provide feedback for process improvement, and support the onboarding of new employees.

Key responsibilities

• Conduct weekly audits of claims and enrollment specialists' work to ensure accuracy and adherence to procedures
• Prepare and maintain detailed audit findings, providing timely feedback and recommendations for process improvements
• Collaborate with internal departments to identify procedural gaps and monitor resolution of system deficiencies affecting quality audits

Required qualifications

• High School Diploma or GED with at least 5 years of experience in healthcare claim processing, or an Associate Degree with 2 years of post-degree experience
• Proficiency in Microsoft Word, Excel, Outlook, and SharePoint
• Knowledge of claims adjudication processes, provider contracting, and member eligibility
• Experience with Medicaid, Medicare, and other third-party payment sources
• Strong understanding of healthcare data analysis and the health insurance industry