Quality Analyst

The primary responsibility of this role is to audit claims to ensure compliance with the Company’s Operational Guidelines (COG) standards.

• Conduct thorough audits of claims to assess compliance with COG standards and internal policies
• Review and analyze claims documentation, ensuring accuracy and completeness
• Identify discrepancies, errors, and areas for improvement in claims processing
• Prepare detailed reports on audit findings, including trends and recommendations for corrective actions
• Collaborate with claims processing teams to provide feedback and training on quality standards and best practices
• Monitor and track the implementation of corrective actions and improvements based on audit findings
• Stay updated on industry regulations, standards, and best practices related to claims processing and quality assurance
• Assist in the development and refinement of quality assurance processes and tools
• Participate in regular quality review meetings and contribute to continuous improvement initiatives
• Support the Manager in special projects and initiatives as needed
• Supports Claims trainer in conducting product training
• Conduct audits of claims during new hire training certification exams

• Minimum of 3 years of experience in claims processing, auditing, or quality assurance within the insurance or healthcare industry
• Strong understanding of claims management processes and COG standards
• Excellent analytical and problem-solving skills with a high attention to detail
• Proficient in using claims management software and Microsoft Office Suite (Excel, Word, PowerPoint)
• Strong communication skills, both written and verbal, with the ability to present findings clearly and effectively
• Ability to work independently and collaboratively in a team environment
• Ability to develop and implement appropriate claims management strategies and plans
• Sound knowledge of claims administration procedures and related systems

• Excellent analytical and problem-solving skills
• Strong communication skills, both written and verbal
• Ability to work independently and collaboratively in a team environment
• Ability to develop and implement appropriate claims management strategies and plans

Our Culture