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Claims QA Analyst
Imagenet LLCClaims Quality Analyst ensuring the accuracy and compliance of claims processing at Imagenet. Collaborating with cross-functional teams to drive continuous improvement and operational excellence.
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingadjudicationroot cause analysisperformance trackingdispute resolutionauditingcompliance assessmentprocess improvementdocumentationanalytical skills
Soft Skills
problem-solvingcommunicationattention to detailtime managementorganizational skills
Certifications
high school diploma or equivalent