Quality Assurance Examiner

Job Summary

Responsible for conducting internal and external audits, the full-time remote Quality Assurance Examiner will analyze claims error data, document policies and procedures, and collaborate with external audit vendors to ensure 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 trends in adjustment and refund activity to recommend improvements

Required qualifications

• Bachelor's degree or equivalent combination of education and work experience
• Three to five years of claims processing experience
• Prior experience in the healthcare or health insurance industry
• Strong analytical skills with the ability to manage multiple priorities
• Demonstrated ability to understand system interactions and their impacts