Quality Assurance Analyst - Health Insurance Claims

Job Description

The Quality Assurance Analyst is to perform monitoring/auditing of the Healthcare Claims Process and to ensure department quality objectives are achieved with the established frequency of audits.

The auditor will be responsible to evaluate skills of each Claims Processors against established quality checklist, which include but are not limited to, accuracy of information updated in all the relevant and required applications, the specific/applicable DLP's are being followed, and relevant Request of Information is sent as applicable. This position will also be responsible for providing required feedback to the team and working with the leadership to suggest required refresher trainings.

Do

• Conduct process quality audits as per plan
  • Conduct various process audits (1 audit/ agent/ week) as per procedure and guidelines
  • For agents identified in the bottom quartile of performance, conduct 3 audits/ agent/ week
  • Prepare findings from the report and share it with the client and the account leadership on daily/ weekly/ monthly, as required
  • Conduct weekly analysis to identify the error trends and for top 2 errors, conduct root cause analysis (RCA)
  • Conduct calibration communication to communicate any changes from the client and conduct refresher trainings to bridge any skill gap due to these changes.

QUALIFICATIONS:

• 4 - 5 years of Experience within the Insurance / Healthcare field with exceptional knowledge of Claims processing
• 2-4 year College Degree in Healthcare preferred/ High School diploma/GED Required. (all education certificates will be verified)
• Excellent Communication Skills (Verbal & Written)
• Should be good with basics of Computer.
• Strong customer service business, operational and procedural knowledge

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