Senior Quality Assurance Analyst

This is a fully remote position, open to applicants in Arizona, +1 more state.

📋 Description

• Execute comprehensive quality audits on claims, Explanation of Benefits (EOBs), mail intake, data capture, and clearinghouse outputs to ensure accuracy, proper benefit application, adherence to contracts, and processing integrity.

• Identify, document, and monitor defects or discrepancies discovered during audits or quality assessments, ensuring that issues are addressed through suitable corrective and preventive measures.

• Investigate complex or escalated issues to grasp the complete workflows, identify root causes, and propose actions to prevent future occurrences.

• Monitor and manage quality concerns submitted through internal systems such as Salesforce, ensuring prompt research, documentation, and resolution.

• Evaluate audit results, trends, and quality performance metrics to identify risks, persistent issues, and systemic weaknesses that need enhancement.

• Create clear and actionable quality reports, dashboards, and summaries that effectively communicate quality status, risks, and improvement progress to leadership and stakeholders.

• Collaborate with Operations to integrate quality controls into everyday workflows, minimizing rework and enhancing first-pass accuracy.

• Work alongside Product, Engineering, Implementation, Automation, and Compliance teams to ensure quality requirements are integrated into system design, configurations, enhancements, and change initiatives.

• Assist in internal and external audit readiness by maintaining clear documentation, audit trails, and evidence that comply with client, regulatory, and SOC-related standards.

• Aid client implementations and operational changes by specifying quality requirements, acceptance criteria, and validation procedures.

• Act as a liaison between Quality Assurance and cross-functional partners to ensure alignment, transparency, and consistent application of quality standards.

• Provide mentorship, guidance, and calibration support to junior QA staff and operational teams, contributing to the development of training materials, SOPs, and job aids.

• Maintain quality documentation, policies, procedures, and artifacts to facilitate operational readiness and compliance.

• Foster a culture of quality, continuous improvement, and accountability throughout the organization.

• Perform other duties as assigned to support the Quality Assurance program.

⛳️ Requirements

• Minimum of 7 years of experience in healthcare payer operations and quality-centric roles.

• Significant hands-on experience in claims processing and payment, coordination of benefits, appeals, and benefit interpretation.

• Strong working knowledge of Medicare and Medicaid program requirements along with related regulatory expectations.

• Experience in conducting quality assurance reviews, operational audits, defect identification, and root cause analysis within payer settings.

• Capability to analyze complex datasets, interpret trends, and translate findings into actionable recommendations.

• Solid understanding of EDI transactions such as 837, 835, and associated healthcare data standards.

• Proven ability to produce clear documentation, maintain comprehensive audit evidence, and ensure alignment with both internal and external compliance expectations.

• Strong problem-solving abilities with the capability to investigate issues thoroughly and recommend effective corrective actions.

• Exceptional verbal and written communication skills, with the ability to collaborate across operational, technical, compliance, and client-facing teams.

• High attention to detail and the capacity to manage multiple priorities in a fast-paced environment.

• Proficient in Microsoft 365 tools, including SharePoint for data repository and workflow management, Power BI for reporting and visualization, Power Automate for process automation, and Excel for data analysis.

• Preferred: Experience with payer systems, benefit configuration, provider contracts, or claims system testing.

• Preferred: Familiarity with SOC audit requirements, NCQA principles, or other quality and compliance frameworks.

• Preferred: Experience in supporting system changes, user acceptance testing, or operational readiness assessments.

🏝️ Benefits

• A company culture that is authentic, innovative, and collaborative!

• Our most powerful strength is our people!

• We build impactful solutions for our customers - their success is our success!

• A professional development and growth-oriented workplace.

• Generous benefits including health insurance, short-term, and long-term disability.

• 401(k) with a company match to secure a better future in your retirement years.

• A flexible environment with a competitive paid time off package; including vacation, holiday, give-back day, and a floating day.