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Claim Association QA Specialist – Part-Time
The Public Interest CompanyClaim Association QA Specialist reviewing healthcare claims for third-party liability. Leveraging coding expertise to analyze claims data and identify recovery opportunities.
About the role
Key responsibilities & impact- Review medical records, claims data, and supporting documentation to identify potential third-party liability (TPL) and recovery opportunities.
- Analyze injury-related claims by connecting accidents, diagnoses, procedures, and treatment timelines.
- Apply ICD-10, CPT, and healthcare coding knowledge to evaluate the accuracy and completeness of claims.
- Identify patterns, discrepancies, and opportunities for recovery through detailed claims and records review.
- Collaborate with operations, product, and engineering teams to improve workflows, review processes, and data quality.
- Document findings clearly and consistently to support downstream recovery efforts.
- Maintain high standards of accuracy while managing multiple cases in a fast-paced, data-driven environment.
- Stay current on coding guidelines, healthcare claims practices, and industry trends to continuously improve review quality.
Requirements
What you’ll need- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Outpatient Coder (COC), or equivalent medical coding credential preferred.
- Strong knowledge of ICD-10 diagnosis coding; experience with RAF reviews, quality reviews, or health plan coding audits is highly desirable.
- Experience reviewing injury-related claims, including personal injury, workers' compensation, auto, or liability claims.
- Background working for a health plan, third-party administrator (TPA), medical billing company, or medical records review organization.
- Familiarity with healthcare claims data, including Explanation of Benefits (EOBs), remittance advice, CPT and ICD-10 coding, and claims documentation.
- Strong analytical skills with exceptional attention to detail and the ability to identify patterns across medical records and claims data.
- Comfortable working in structured, data-driven environments and making consistent, evidence-based determinations.
Benefits
Comp & perks- Make a meaningful impact by helping ensure healthcare claims are paid accurately and recovering funds that support patient care.
- Apply your clinical and coding expertise to solve complex, real-world cases at the intersection of healthcare, data, and legal operations.
- Join a collaborative, fast-growing team where your work directly influences product development, operational strategy, and client outcomes.
- Grow your career in an innovative healthcare technology company transforming how third-party liability claims are identified and recovered.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
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Hard Skills & Tools
ICD-10 CodingCPT CodingClaims DocumentationData AnalysisQuality ReviewsHealthcare Coding KnowledgeClaims ReviewPattern IdentificationEvidence-Based DeterminationsRemittance Advice
Soft Skills
Attention to DetailAnalytical SkillsCollaborationCommunication
Certifications
Certified Professional Coder (CPC)Certified Coding Specialist (CCS)Certified Outpatient Coder (COC)