8 дней назад
Quality Analyst (Clinical Claims) - Pooling
Вакансия из Hirify Global, списка международных tech-компанийДля мэтча и отклика нужен Plus
Мэтч & Сопровод
Для мэтча с этой вакансией нужен Plus
Описание вакансии
Текст:
TL;DR
Quality Analyst (Clinical Claims) - Pooling (Healthcare Quality Assurance): Monitoring and improving the quality of clinical claim reviews, medical documentation assessments, customer interactions, and operational processes with an accent on auditing, compliance, and quality reporting. Focus on analyzing root causes, coaching clinical claims associates and nurses, supporting calibration, and driving corrective actions across clinical operations.
Location: Taguig, Philippines
Company
Provides AI, automation, cloud engineering, advanced analytics, and business process services for global brands.
What you will do
- Audit clinical claim reviews and related transactions for accuracy, completeness, compliance, and consistency.
- Maintain quality scorecards and audit documentation while analyzing trends, root causes, and performance gaps.
- Prepare quality reports and recommend corrective and preventive actions to Operations leaders and stakeholders.
- Provide feedback to Clinical Claims Associates and Nurses and support performance improvement plans.
- Support calibration sessions, quality frameworks, process improvement initiatives, and continuous improvement programs.
- Collaborate with Operations, Training, Workforce Management, Clinical, and Client Services teams on quality governance.
Requirements
- Active and unrestricted US Registered Nurse license required.
- At least 2 years of recent clinical experience in hospital, utilization management, case management, disability, health insurance, or related healthcare settings.
- At least 1 year of Quality Analyst experience in a BPO, healthcare, insurance, claims, or clinical operations environment.
- Strong knowledge of healthcare documentation, claim review processes, medical terminology, quality methodologies, auditing, and root cause analysis.
- Experience with performance monitoring, quality scorecards, reporting, coaching, and Microsoft Office, especially Excel and PowerPoint.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
Nice to have
- Experience with Disability Claims, Clinical Claims, Group Benefits, or Insurance Operations accounts.
- Knowledge of disability management or absence management programs.
- Experience with quality calibrations, client-facing quality reviews, quality management systems, and reporting tools.
- Lean Six Sigma Yellow Belt or equivalent quality certification.
Culture & Benefits
- Work within an AI, automation, cloud engineering, and advanced analytics environment.
- Collaborate across Operations, Training, Workforce Management, Clinical, and Client Services functions.
- Contribute to continuous improvement, quality governance, and client quality discussions.
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