Claims Quality Assurance Analyst (Commercial Health)

Minimum of 3-5 years commercial health plan experience 2-3 years experience performing the QA function for claims Solid knowledge of medical and insurance industry terminology Excellent communicator, both verbally and in writing Comfortable in a fast-paced, deadline-oriented work environment Strong attention to detail and problem-solving skills Skilled at identifying and implementing tools to improve the QA process Proficient in Microsoft Office applications (Word, Excel, Outlook, OneNote) Prior experience using a CRM, preferably Salesforce

Develop/formalize the audit program Perform quality responsibilities for claim accuracy Become a SME in claims Propose documentation updates, automation, or process changes Report on trends and training opportunities Report out results to employees and summarize performance Follow up on errors to ensure claims are corrected Develop a rebuttal process Create monthly KPI report