Senior Quality Analyst

A company is looking for a Senior Quality Analyst who will oversee contract and benefit configuration to ensure accurate claims processing and network compliance.

Key Responsibilities

Audit system configuration against contract requirements

Collaborate with IT and operations to resolve claims configuration gaps

Perform routine and complex audits of claim transactions to validate results

Required Qualifications

5+ years of advanced claims adjudication experience

Minimum 3 years in auditing of claims adjudication

Working knowledge of medical terminologies and coding

Experience with building and running SQL queries

Strong organizational skills and ability to multitask