Evry Health

Analyst

• Evry Health is seeking a Healthcare Claims Quality Analyst to support our claims operations team.
• The Quality Analyst will perform in-depth audits of medical claims processing to ensure payment accuracy, healthcare compliance, and adherence to plan benefits and industry regulations.
• Conduct detailed quality audits on complex medical claims, disputes, payment adjustments, and medical claim adjudication decisions.
• Exceed member and provider expectations through excellent quality results.
• Report on trends and training opportunities.
• Develop a rebuttal process to ensure errors are appropriately assigned.
• Create monthly KPI report that summarizes results, top error trends and recommendations for closing any gaps.

Healthcare Claims Quality Analyst

Data Analyst

• Data Extraction and Management: Pull health plan, member, provider, and operations data from various sources and databases using SQL.
• Data Analysis: Analyze large datasets to identify trends, patterns, and discrepancies across different types of operating data.
• Reporting and Visualization: Create reports, dashboards, and visualizations to present complex findings in an accessible format for both technical and non-technical audiences/stakeholders.
• Collaboration: Work with teams across the company to manage different types of data requests and to implement and evaluate data-driven solutions.
• Data Quality: Ensure data integrity across our systems by identifying discrepancies and recommending/implementing data capture and maintenance standards/processes.

Senior Business Data Analyst – Commercial Health Insurance

Call Center Representative

• Provide accurate and thorough information on commercial health plan benefits, eligibility, and claims.
• Handle inbound and outbound calls as well as respond to email inquiries from customers.
• Responsible for developing processes, call scripts, metrics, and desk top procedures.
• Deliver an exceptional customer service experience to Evry members and providers.
• Report to the Director of Operations and partner with senior leadership daily.

Commercial Health Call Center Representative

QA Engineer

• In collaboration with the VP of Operations, develop/formalize the audit program, including the appropriate statistical sample size, quality results report, employee scorecard, error taxonomy, etc.
• Perform a wide range of quality responsibilities aimed at maintaining service excellence and driving continuous improvement in claim accuracy.
• Become a SME in claims, utilizing all tools and desk level procedures to guide evaluation of Claim Analyst performance.
• Propose documentation updates, potential automation or changes to improve the processing experience.
• Report on trends and training opportunities.
• Report out results to the employee and summarize weekly performance into monthly results.
• Follow up on errors to ensure claims are corrected prior to check run.
• Develop a rebuttal process to ensure errors are appropriately assigned.
• Create monthly KPI report that summarizes results, top error trends and recommendations for closing any gaps.

Claims Quality Assurance Analyst – Commercial Health

Recruitment

• Partner with hiring managers and leaders to define role requirements, build effective job postings, and create consistent, structured interview processes.
• Manage the full recruitment lifecycle, from sourcing and outreach to offer negotiation and onboarding handoff.
• Develop and implement sourcing strategies to engage diverse, high-quality talent using platforms, networks, and creative approaches.
• Review resumes, conduct interviews, and assess candidates to ensure a good fit for the role and the company.
• Act as a trusted advisor to hiring teams, providing guidance on talent market trends and candidate assessment.
• Maintain strong pipelines of active and passive candidates for key role families within the organization, considering the company's overall goals and hiring plans.
• Ensure a "white glove" candidate experience with clear communication, timely feedback, and high-touch interactions.
• Track and report on recruiting metrics (i.e. pipeline, time-to-hire, candidate satisfaction, etc.).
• Collaborate with the HR Manager on employer branding initiatives and process improvements.
• Optimize our ATS, Lever, to create efficient processes that are compliant and incorporate automation.
• Maintain ATS hygiene and act as a subject matter expert on relevant tools, systems, and workflows, providing proactive training as necessary.

Healthcare Claims Quality Analyst

Senior Business Data Analyst – Commercial Health Insurance

Commercial Health Call Center Representative

Claims Quality Assurance Analyst – Commercial Health

Talent Acquisition Partner