Quality Analyst (Clinical Claims)
Core
Monitor, evaluate, and improve the quality of clinical claim operations, ensuring adherence to client guidelines, regulatory standards, and internal quality expectations.
Role type
Quality Analyst (Clinical Claims)
Builds
Quality scorecards, audit documentation, and performance improvement plans for clinical claims operations.
Domain
Healthcare / Insurance / Clinical Claims
Deliverable
dashboards & analysis
Required skills
Clinical claims review, medical documentation assessment, HIPAA compliance, root cause analysis, quality auditing, performance monitoring, coaching, Microsoft Excel, Microsoft PowerPoint
Preferred skills
Disability claims experience, absence management, quality calibrations, Lean Six Sigma Yellow Belt, quality management systems
Responsibilities
Conduct audits of clinical claim reviews, analyze quality trends and performance gaps, provide feedback to associates and nurses, ensure compliance with healthcare regulations, collaborate with Operations and Training teams
Seniority
Mid-level, hands-on IC
