Quality Analyst (Premium Healthcare)

As a Quality Review & Audit Lead Representative you will audit claims for accuracy and compliance with an opportunity for growth and development across multiple audit areas including pre‑disbursement. Our team provides feedback and helps with trend improvement and coaching opportunities for the claims organization. In this role you will have an opportunity to influence the customer journey.

Education & Experience

• High School Diploma or GED
• 2+ years claims processing experience using Proclaim with Skill 1, Skill 2, and Skill 3
• Complex Claim experience (e.g., stop loss and level of care) highly preferred

Mandatory Skills

• Customer Service Focused: Commitment to exceeding partner and customer expectations
• Critical Thinking: Proven track record in making informed decisions and solving problems effectively
• Process Improvement: Ability to identify trends and...