Healthcare Claims Quality Analyst

Job Summary

Focused on claims auditing and quality assurance, the full-time Healthcare Claims Quality Analyst will monitor production quality, evaluate claim transactions, and support continuous improvement initiatives in a remote environment.

Key responsibilities:

• Monitor claims quality and audit functions, supporting other operational departments as needed
• Conduct claims audit reviews to ensure accuracy, compliance, and proper documentation
• Identify and trend audit findings, communicating actionable insights to leadership and operations partners

Required qualifications:

• Minimum of 1 year of claims auditing experience with knowledge of commercial, Medicaid, and Medicare billing rules
• Working knowledge of Revenue Cycle Management (RCM) workflows and their impacts
• Consistent track record of achieving high-quality scores in previous roles
• Proficiency in QA methodologies and quality monitoring practices
• Bachelor's Degree preferred or equivalent experience