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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.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical coding, particularly ICD-10 and CPT, with a strong focus on analyzing injury-related claims and identifying recovery opportunities. Maintains accuracy and attention to detail while collaborating with cross-functional teams to enhance workflows and data quality.
Highest-signal resume keywords
ICD-10 Diagnosis CodingClaims Data AnalysisCertified Professional Coder (CPC)Injury-Related Claims ReviewHealthcare Claims Practices
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
ICD-10 CodingCPT CodingClaims DocumentationData AnalysisQuality ReviewsHealthcare Coding KnowledgeClaims ReviewPattern IdentificationEvidence-Based DeterminationsRemittance Advice
Soft Skills
Attention to DetailAnalytical SkillsCollaborationCommunication
Certifications & Qualifications
Certified Professional Coder (CPC)Certified Coding Specialist (CCS)Certified Outpatient Coder (COC)
Industry Keywords
Third-Party Liability (TPL)Personal Injury ClaimsWorkers' CompensationAuto Liability ClaimsHealth Plan Coding AuditsMedical BillingExplanation of Benefits (EOBs)Data-Driven EnvironmentMedical Records ReviewHealthcare Trends
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.