Claims QA Analyst
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Claims Quality Analyst ensuring the accuracy and compliance of claims processing at Imagenet. Collaborating with cross-functional teams to drive continuous improvement and operational excellence.
Responsibilities:
- Perform detailed audits of denied, underpaid, and processed claims using EZCap to assess accuracy and compliance with provider contracts and regulatory guidelines.
- Analyze provider disputes for patterns or recurring issues.
- Identify root causes and work with relevant teams to implement corrective actions and process improvements.
- Develop and track performance related to claims accuracy, turnaround time, and dispute resolution efficiency.
- Conduct thorough root cause analyses on high-impact errors or escalations.
- Support training initiatives by identifying knowledge gaps and assisting in the development of updated procedures and documentation based on audit results.
- Ensure all reviewed processes align with applicable regulatory requirements.
- Participate in internal and external audits as needed.
Requirements:
- High school diploma or equivalent
- At least 3-5 years of Quality Analyst in healthcare, TPA, or health plan settings/ healthcare claims or in a claims processing/adjudication environment
- Hands-on experience with EZCap (strongly preferred)
- Familiarity with Medi-Cal and Commercial insurance claim
- Strong analytical and problem-solving skills
- Excellent verbal and written communication
- Attention to detail in documentation and compliance
- Ability to manage multiple tasks and meet deadlines
- Experience with other claim adjudication platforms and provider systems
- Familiarity with DHCS, DMHC, CMS dispute handling regulations.
Benefits:
- Remote work offered
- Equipment provided
- Paid training to set you up for success
- Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
- Paid Time Off (PTO)
- 7 paid holidays
- A supportive team and a company that values internal growth
Similar Jobs
Gerente de Testes, QA
Gerente de QA liderando e estruturando frentes de testes em projetos SAP S/4HANA na EVT. Buscamos um profissional colaborativo com mais de 5 anos de experiência em projetos SAP.
QA Claims Administrator
Quality Assurance Administrator supporting franchise quality assurance across 340 locations in North America. Ensuring compliance with insurance carrier standards and managing claims effectively.
QA Claims Administrator
Quality Assurance Administrator supporting franchise network by ensuring compliance and quality standards in insurance claims processing. Reviewing files, monitoring metrics, and collaborating with teams.
Web Application Penetration Tester
Penetration Tester for KirkpatrickPrice focusing on web application security, mobile applications, APIs, and AI security assessments. Passionate about teaching and mentoring clients on cybersecurity practices.
Manager, IT Quality Assurance
Manager, QA responsible for technology services quality assurance standards and team leadership in a not-for-profit organization. Leading processes to maximize benefits in digital transformation strategy.
Dynamics CRM QA Analyst
QA Engineer with experience in testing Dynamics 365 CRM applications. Collaborating with teams to ensure quality through design, testing, and reporting.
Quality Assurance Specialist 3
Quality Assurance Specialist ensuring compliance with nuclear quality standards for NuScale Power's projects. Responsible for audits, process development, and supplier oversight in quality assurance.
Analista de Qualidade, QA
Quality Analyst ensuring product quality at Brazil's leading education company. Collaborating within agile squads to deliver high-quality software solutions.
Specialist Supplier Quality Engineer
Supplier Quality Engineer ensuring supplier performance and process improvements. Collaborating with internal teams and suppliers in aerospace manufacturing environment.
QA/RA Lead Engineer
Lead Engineer providing quality, compliance, and regulatory services across life sciences projects. Mentoring junior engineers and ensuring high delivery standards while managing client relationships.
Principal QA Engineer
Principal QA Engineer leading and mentoring QA team at Sphera to drive quality assurance excellence through both manual and automated testing practices.
Product Quality Engineer
Seeking a Product Quality Engineer to manage user feedback and enhance product quality remotely. Collaborate across teams to improve experiences and drive product decisions.
QA Engineer
Quality Engineer at Medline managing quality assurance across various medical devices in a remote role. Involvement in process validation, quality issue handling, and vendor management.
Senior Quality Assurance Engineer – Mobile Applications
Senior Mobile QA Engineer leading quality strategy for mobile applications at Irth. Designing and scaling automation frameworks while ensuring performance and stability across iOS and Android devices.
Senior QA Engineer – E-commerce
Quality Engineer ensuring automated testing for distributed systems at Truelogic, a provider of nearshore staff augmentation services, delivering technology solutions for companies.
Senior QA Engineer – E-commerce
Quality Engineer ensuring reliability and integrity of complex applications at a lifestyle brand e-commerce company. Designing automated testing strategies for web UIs, APIs, and data flows.
Senior QA Engineer – E-commerce
Quality Engineer ensuring reliability of complex, multi-layered applications for a lifestyle brand connecting artists and customers. Focus on automated testing strategies for web UIs, APIs, and data flows.
Senior QA Engineer – E-commerce
Quality Engineer focusing on automated testing for APIs and web UIs at a design marketplace. Collaborating with top U.S. companies on impactful projects.
Vice President – Regulatory Affairs, Quality Assurance, Quality Control
Vice President managing regulatory affairs and quality control at a global medical technology leader. Executing global strategies and overseeing compliance and quality excellence.
Vice President, Regulatory Affairs, Quality Assurance, Quality Control
Vice President leading global regulatory and quality assurance for innovative medical aesthetic technology company Venus Concept. Drive compliance, quality excellence, and operational rigor across the organization.