Quality Assurance Examiner

Job Summary

Seeking a full-time remote Quality Assurance Examiner, the candidate will be responsible for conducting internal and external audits, analyzing claims error data, and processing vendor recoveries while ensuring compliance and accuracy in claims processing.

Key responsibilities

• Conduct internal audits of high-dollar claims and adjustment transactions
• Process claim adjustments, refunds, recoveries, voids, and reissues
• Analyze adjustment and refund activity to identify trends and recommend improvements

Required qualifications

• Bachelor's degree or equivalent combination of education and experience
• Three to five years of claims processing experience in the healthcare or health insurance industry
• Strong analytical skills with a proven ability to manage multiple priorities
• Demonstrated ability to understand system interactions and their impacts
• Commitment to continuous improvement in operational efficiency and quality