Remote Claims QA Analyst (Healthcare)

TL;DR

Remote Claims QA Analyst (Healthcare): Perform detailed audits of denied, underpaid, and processed claims using EZCap with an accent on accuracy, compliance with provider contracts, and regulatory guidelines for Medi-Cal and commercial health plans. Focus on analyzing provider disputes, identifying root causes, implementing corrective actions, and supporting training initiatives.

Location: Remote (US, Omaha, Nebraska context). US-based benefits including 401(k) and HSA.

Company

Leading provider of back-office support technology and outsourced claims processing services to over 70 US healthcare plans nationwide.

What you will do

• Perform detailed audits of claims using EZCap to assess accuracy and compliance.
• Analyze provider disputes for patterns and recurring issues.
• Identify root causes and collaborate on corrective actions and process improvements.
• Develop and track metrics for claims accuracy, turnaround time, and dispute resolution.
• Conduct root cause analyses on high-impact errors and escalations.
• Support training by identifying knowledge gaps and updating procedures based on audits.

Requirements

• High school diploma or equivalent.
• 3-5 years as Quality Analyst in healthcare, TPA, health plans, or claims processing.
• Hands-on experience with EZCap (strongly preferred).
• Familiarity with Medi-Cal and commercial insurance claims.
• Strong analytical, problem-solving, and communication skills.
• Attention to detail, multitasking, and deadline management.

Nice to have

• Experience with other claims adjudication platforms and provider systems.
• Familiarity with DHCS, DMHC, CMS regulations.

Culture & Benefits

• Remote work with equipment provided.
• Paid training and comprehensive benefits: medical, dental, vision, life, HSA, 401(k).
• Paid Time Off (PTO) and 7 paid holidays.
• Supportive team focused on internal growth.