Quality Assurance Analyst I

About the Role

Key Responsibilities

• Conduct audits and reviews of claims to ensure compliance with industry regulations, company policies, and procedures, verifying that payments were made correctly and in accordance with appropriate plans and policies
• Analyze claims data to identify trends, patterns, and opportunities for improvement
• Develop and implement quality assurance processes and procedures to improve the overall claims process
• Maintain relationships with clients' audit teams, providing support during audits and managing action points
• Create reports and analysis on claims quality, including trends, patterns, and opportunities for improvement; communicate findings to Claims stakeholders and identify opportunities to increase use of data in identifying trends
• Identify and analyze potential risks and fraud within the claims process
• Assist with developing training materials, documentation, quick reference guides, and facilitate training sessions with the claims team
• Stay up-to-date on industry trends, regulations, and best practices related to claims quality assurance
• Participate in both internal and external audits as needed

Requirements

• Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications)
• 2 years of experience in claims quality assurance or related field
• Preferred prior claim adjuster handling experience
• Experience with claims regulatory and unfair practices act statutory compliance preferred
• Strong analytical skills and attention to detail
• Ability to work independently and as part of a team in a fast-paced environment
• Strong familiarity with industry best practices, but an equally strong comfort in thinking critically about easier, even better ways of working
• Experience with data analytics tools

Nice to Have

• Prior claim adjuster handling experience
• Experience with claims regulatory and unfair practices act statutory compliance

Qualifications

• Bachelor's degree (preferred but not mandatory if other qualifications are met)

Benefits & Perks

• Generous health-insurance package with nationwide coverage, vision, & dental
• 401(k) retirement plan with employer matching
• Competitive PTO policy
• Generous family leave policy
• Work from anywhere paired with frequent, regular corporate retreats
• Apple laptop, large second monitor, and other quality-of-life equipment