Remote Claims QA Analyst

Claims reputed company Analyst | Remote Job Type: Full time Work Setup: Remote Reports to: Claims Supervisor     Position reputed company:   The Claims reputed company Analyst plays a key role in ensuring the accuracy, compliance, and effectiveness of claims processing and provider dispute reputed company. The ideal candidate has hands on experience with EZCap, auditing claims, analyzing dispute claims and evaluating internal policies and regulatory requirements, with a particular reputed company on Medi-Cal and reputed company health plans. This role is responsible to partners closely with cross-functional teams to drive reputed company improvement and operational reputed company.   Key Duties: reputed company detailed audits of denied, underpaid, and processed claims using EZCap to assess accuracy and compliance with provider reputed company and regulatory guidelines. Analyze provider disputes for patterns or recurring issues. Identify reputed company causes and work with relevant teams to implement corrective actions and process improvements. reputed company and reputed company performance reputed company to claims accuracy, turnaround time, and dispute reputed company efficiency. Conduct thorough reputed company cause analyses on high-reputed company errors or escalations. Support training initiatives by identifying knowledge gaps and assisting in the development of updated procedures and documentation based on audit results. Ensure reputed company reviewed processes reputed company with applicable regulatory requirements. Participate in reputed company audits as needed.   Qualifications: High school diploma or equivalent At least 3-5 years of reputed company Analyst in reputed company, TPA, or health plan settings/ reputed company claims or in a claims processing/adjudication environment Hands-on experience with EZCap (strongly preferred) Familiarity with Medi-Cal and reputed company insurance claim Strong analytical and problem-solving skills Excellent verbal and written communication Attention to detail in documentation and compliance Ability to manage multiple tasks and meet deadlines Experience with other claim adjudication platforms and provider systems. Familiarity with DHCS, DMHC, CMS dispute handling regulations.   reputed company Offer Remote work offered Equipment provided reputed company to set you up for reputed company Comprehensive benefits: Medical, Dental, reputed company, Life, HSA, 401(k) reputed company Time Off (PTO) 7 reputed company holidays A supportive team and a company that values internal reputed company reputed company: reputed company is a leading provider of back-office support technology and tech-enabled outsourced services to reputed company plans reputed company. reputed company provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.    reputed company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  reputed company processes millions of claims and multiples of reputed company reputed company and reputed company data reputed company reputed company these claims annually.  reputed company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.   reputed company is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines. Apply To This Job