Claims Quality Assurance Analyst (Remote)

About Our Client:

The organization operates within the healthcare sector, focusing on claims and reimbursement processes. It addresses the challenge of ensuring accuracy and completeness in claims processing, particularly within Medicaid, Medicare, and other third-party payment sources. The organization supports effective healthcare delivery by maintaining high standards in claims adjudication and member eligibility verification.

About the Opportunity:

The CLAIMS QUALITY ASSURANCE ANALYST role is responsible for conducting quality reviews of claims and eligibility work to ensure accuracy and completeness. This position impacts the organization's operational effectiveness by identifying trends and providing feedback to improve coaching, training, and process enhancements. It also supports onboarding new employees, contributing to workforce development and quality assurance.

Responsibilities:

• Perform weekly internal quality audits of claims and enrollment work
• Evaluate adherence to standard operating procedures and accuracy of work
• Document quality reviews by work type and functional area
• Conduct onboarding audits for new employees and provide coaching feedback
• Report audit findings and recommend process improvements
• Prepare audit reports and serve as subject matter expert for quality questions
• Track open audit items and advocate for timely resolution
• Use audit trends to support departmental training efforts
• Collaborate with internal partners to address procedural gaps and system issues
• Perform other duties as assigned

Requirements:

• High School Diploma or GED with 5 years healthcare claim processing experience, or Associate Degree with 2 years post-degree healthcare claims experience
• Knowledge of Medicaid, Medicare, and third-party payment sources
• Proficiency in Microsoft Word, Excel, Outlook, SharePoint
• Ability to learn claims adjudication and multi-payer management systems quickly
• Strong attention to detail and data accuracy
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong time management and decision-making capabilities
• Understanding of healthcare data analysis and claims processing
• Residency in NC, SC, GA, TN, VA, MD, or FL

Pay Range and Compensation Package:

Salary depends on qualifications and experience; position is exempt and not eligible for overtime compensation.

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company's career page or ATS.