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Quality Control Analyst

AnalystAnalystFull TimeRemoteJuniorTeam 201-500Since 1981H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

31 days ago

Salary

$26 - $28 / hour

Seniority

Junior

Associate Degree1 yr expExperience acceptedEnglishSQL

Job Description

Quality Control Analyst

Health Plans, Inc.

• Conduct regular audits of financial transactions related to claims funding, billing, and stop loss submissions processed by the teams to ensure adherence to industry regulations and internal policies & procedures • Review and analyze reports to identify discrepancies, errors, or trends that may impact financial performance • Support all external audit requests and audit of materials gathered prior to submission • Maintain accurate and organized records of all quality control activities, including audit results, corrective actions taken, and follow-up measures • Act as a subject matter expert for projects aimed at process improvement and operational excellence • Recommend process changes based on audit findings and industry standards to improve overall service delivery • Prepare detailed reports summarizing findings and presenting them in a clear and actionable format to management • Participate in cross-functional meetings to discuss quality issues and propose solutions • Accountable for reaching target metrics related to quality & performance improvements • Assist in the development of departmental policies and procedures • Provide training and support to staff on quality control processes and compliance requirements • Assist with researching and resolution of client issues • Assess the need for a sense of urgency with all work activities and communicate appropriately with department leadership to coordinate response/resolution.

Job Requirements

  • Associate’s degree or equivalent work experience
  • Previous experience in quality control, auditing, or compliance within the finance or healthcare insurance sector
  • Strong analytical skills and high attention to detail and accuracy
  • Strong organizational skills with the ability to manage multiple priorities
  • Work within specified timeframe and meet deadlines.
  • Strong customer service orientation and ability to build relationships.
  • Excellent knowledge of MS Office & proficient in data analysis tools and software (e.g. Excel, SQL)
  • Effective verbal and written communication skills; experienced in collaborating with internal teams, vendors, and customers to resolve inquiries.

Benefits

  • Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the duties and responsibilities of the position.

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