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 manage vendor interactions to ensure compliance and accuracy in claims processing.

Key responsibilities

• Conduct internal audits of high-dollar claims and adjustment transactions
• Partner with external audit vendors to ensure audit accuracy and address inquiries
• Analyze adjustment and refund activity to identify trends and recommend improvements

Required qualifications

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