Remote Claims Quality Analyst

Job Summary

Remote Claims Quality Analyst, responsible for ensuring the accuracy and compliance of claims processing in a full-time remote role, focusing on auditing and analyzing claims and provider disputes.

Key Responsibilities

• Perform detailed audits of claims to assess accuracy and compliance with contracts and regulations
• Analyze provider disputes for patterns and implement corrective actions for process improvements
• Support training initiatives and ensure alignment with regulatory requirements through audits

Required Qualifications

• High school diploma or equivalent
• At least 3-5 years of experience as a Quality Analyst in healthcare or claims processing environments
• Hands-on experience with EZCap (strongly preferred)
• Familiarity with Medi-Cal and Commercial insurance claims
• Experience with other claim adjudication platforms and provider systems