Healthcare Claims Quality Analyst

Job Summary

A company is looking for a Healthcare Claims Quality Analyst to support claims operations through auditing and ensuring compliance.

Key Responsibilities

• Develop and formalize the audit program, including statistical sampling and quality reporting
• Perform quality audits on medical claims to maintain service excellence and improve accuracy
• Report trends, training opportunities, and summarize performance results for stakeholders

Required Qualifications

• 3-5 years of commercial health plan experience
• 2-3 years of experience in claims auditing or quality review functions
• Expertise in medical claims adjudication and healthcare claims processing
• Familiarity with healthcare compliance requirements and claim processing regulations
• Proficiency in Microsoft Office applications