Quality Specialist
3 days ago
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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