Quality Specialist

5 days ago

Coimbatore, India Golden Opportunities Full time

Job Overview:

  • We are seeking a detail-oriented and experienced Quality Specialist with a strong background in US Healthcare processes, specifically in claims adjudication.
  • This is a non-voice role focused on ensuring accuracy, compliance, and continuous improvement in healthcare claim processing.
  • The ideal candidate will bring analytical rigor, process knowledge, and a passion for quality assurance.

Key Responsibilities:

  • Conduct audits of healthcare claims to ensure accuracy and compliance with US healthcare regulations and payer guidelines
  • Identify trends, errors, and areas of improvement in claims adjudication processes
  • Collaborate with operations and training teams to address quality gaps and implement corrective actions
  • Prepare and present audit reports, dashboards, and performance metrics
  • Maintain documentation of audit findings and follow-up actions
  • Support process improvement initiatives and contribute to SOP updates
  • Ensure adherence to HIPAA and other regulatory standards.

Skills & Attributes:

  • Minimum 3.6 years of experience in US healthcare domain, with at least 1 year as a Quality Analyst
  • Strong understanding of claims adjudication workflows and terminologies
  • Excellent analytical and problem-solving skills
  • Proficiency in MS Excel, audit tools, and reporting platforms
  • Ability to work independently in a fast-paced, deadline-driven environment
  • Strong written communication skills (non-voice role)
  • Familiarity with HIPAA compliance and payer-specific guidelines.

Contact Person - Brindha Kamaraj

Email -

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