Claims Quality Assurance Analyst – Commercial Health
Evry Health
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- 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.
Requirements
- You have a minimum of 3-5 years commercial health plan experience
- You have 2-3 years’ experience performing the QA function for claims.
- You have a solid knowledge of medical and insurance industry terminology.
- You are an excellent communicator, both verbally and in writing and can articulate and communicate complex topics to a broad audience.
- You can perform comfortably in a fast-paced, deadline-oriented work environment.
- You possess strong attention to detail and problem-solving skills with a high level of accuracy.
- You are not afraid to express new ideas or suggestions for improving processes.
- You are skilled at identifying and implementing tools to improve the QA process, including QA reporting and tracking mechanisms to allow easy identification of trends or quality issues.
- You collaborate with and support business and operational units across the organization.
- You are proficient in Microsoft Office applications Word, Excel, Outlook OneNote, etc.
- You have prior experience using a CRM, preferably Salesforce.
Benefits
- Competitive salary
- Comprehensive health, dental, and vision insurance as well as life and disability
- Retirement savings plan with company match
- Generous time off/vacation
- Professional development opportunities
- Flexible and remote work environment
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
quality assuranceclaims evaluationstatistical analysisKPI reportingerror taxonomyprocess improvementautomationtrend analysisdocumentation updatesproblem-solving
Soft skills
communicationattention to detailcollaborationadaptabilitycreativityorganizational skillstime managementcritical thinkinginterpersonal skillspresentation skills