Quality Assurance Examiner

Health Plans, Inc.

Quality Assurance Examiner responsible for conducting audits and processing claims at HPI, an established health solutions provider. Ensuring accuracy and compliance in a supportive work environment.

Posted 7/16/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $31 - $33 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in conducting internal audits of high-dollar claims and adjustments, with a strong focus on analytical skills to identify trends and recommend process improvements. Proven ability to collaborate with external vendors and maintain compliance within healthcare claims processing.

Highest-signal resume keywords

Claims Processing ExperienceHealthcare Industry KnowledgeAnalytical SkillsCommunication SkillsAttention to Detail

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Internal AuditsClaims AdjustmentsRefund ProcessingTrend AnalysisRoot Cause AnalysisDocumentation ManagementAudit ReportingOperational Improvement

Soft Skills

Problem-SolvingOrganizational SkillsTime ManagementCollaborationJudgment

Industry Keywords

HealthcareHealth InsuranceComplianceContinuous ImprovementOperational Efficiency

About the role

Key responsibilities & impact

Conduct internal audits of high-dollar claims and adjustment transactions, including audits exceeding $50,000 to $100,000+.
Partner with external audit vendors to address questions, provide feedback, and ensure audit accuracy.
Process claim adjustments, refunds, recoveries, voids, reissues, and Medicare demand transactions.
Analyze adjustment and refund activity to identify trends, determine root causes, and recommend process, training, or system improvements.
Investigate potential operational or payment issues and provide recommendations to management.
Collaborate with provider billing vendors to request refunds, process claim adjustments, and review audit-related correspondence.
Monitor and track adjustment activity, maintaining accurate documentation and reporting.
Prepare and present monthly department audit results and key findings.
Support continuous improvement initiatives by identifying opportunities to enhance accuracy, efficiency, and compliance within claims and audit processes.

Requirements

What you’ll need

Bachelor’s degree or an equivalent combination of education and work experience.
Three to five years of claims processing experience required.
Prior experience in the healthcare or health insurance industry required.
Strong analytical and problem-solving skills with exceptional attention to detail.
Ability to manage multiple priorities in a fast-paced environment while maintaining a high degree of accuracy.
Excellent organizational and time management skills with the ability to meet deadlines.
Effective verbal and written communication skills, with the ability to interact professionally across all levels of the organization.
Ability to work independently while also contributing collaboratively as part of a team.
Demonstrated ability to understand system interactions and identify the downstream impact of process changes.
Proven ability to follow through on assignments, proactively address issues, and ensure timely resolution.
Sound judgment and discretion in handling confidential and sensitive information.
Commitment to continuous improvement and identifying opportunities to enhance quality, accuracy, and operational efficiency.

Benefits

Comp & perks

Medical, Dental and Vision and Prescription Drug Coverage
Fitness Reimbursement Benefit
Employee Assistance Program
Flexible Spending Account & Health Savings Account
401(k) and Quarterly Bonuses
Generous Paid-Time Off & Volunteering Opportunities
Educational Assistance & Professional Development Opportunities