Claims Qa Analyst

Job summary
Claims QA Analyst position in Doral, FLHybrid remote work scheduleConducts audits and identifies problems to ensure quality standards
Job seniority: mid-to-senior level
Responsibilities
• Conduct audits of AvMed, Delegated Vendors, and BPO claims• Identify and correct audit findings• Coordinate with BPO and Delegated Vendors to finalize audit findings• Analyze system errors and initiate corrective actions• Maintain data integrity and conduct quality improvement studies• Review vendor initiatives and make recommendations• Conduct system testing and troubleshooting• Conduct random audit samples of claims• Represent Manager in meetings• Provide comprehensive claims analysis to management
Requirements
• 6-10 years of experience in a complex managed care environment• Experience in claims, pricing, and/or benefits• Previous audit or system configuration experience preferred• Associates degree required, Bachelor's in health sciences preferred• Strong communication, analytical, and organizational skills• Detail-oriented and ability to handle multiple tasks and deadlines• Knowledge of medical coding and software systems• Proficiency in Microsoft Office Suite
Key Skills Needed
• Strong verbal and written communication skills• Strong analytical and interpretative skills• Excellent organizational skills• Effective problem-solving skills• Detail-oriented skills• Medical coding (CPT, HCPCS, ICD-10, DRG)• HRP, MACESS, or Similar Software Systems• Microsoft Office Suite
Benefits
• Medical, Dental, and Vision Insurance• Paid Annual Leave, Sick Leave• Flexible Spending Accounts• Retirement funds with matching contribution• Supplemental insurance policies• Work Perks program• Opportunities for advancement• Comprehensive employee benefits