Remote Claims QA Analyst

ImagenetLLC • Omaha, NE

1d • Remote

About The Position

The Claims Quality Analyst plays a key role in ensuring the accuracy, compliance, and effectiveness of claims processing and provider dispute resolution. The ideal candidate has hands on experience with EZCap, auditing claims, analyzing dispute claims and evaluating internal policies and regulatory requirements, with a particular focus on Medi-Cal and commercial health plans. This role is responsible to partners closely with cross-functional teams to drive continuous improvement and operational excellence.

Requirements

• High school diploma or equivalent
• At least 3-5 years of Quality Analyst in healthcare, TPA, or health plan settings/ healthcare claims or in a claims processing/adjudication environment
• Hands-on experience with EZCap (strongly preferred)
• Familiarity with Medi-Cal and Commercial 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.

Responsibilities

• Perform detailed audits of denied, underpaid, and processed claims using EZCap to assess accuracy and compliance with provider contracts and regulatory guidelines.
• Analyze provider disputes for patterns or recurring issues.
• Identify root causes and work with relevant teams to implement corrective actions and process improvements.
• Develop and track performance related to claims accuracy, turnaround time, and dispute resolution efficiency.
• Conduct thorough root cause analyses on high-impact 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 all reviewed processes align with applicable regulatory requirements.
• Participate in internal and external audits as needed.

Benefits

• Remote work offered
• Equipment provided
• Paid training to set you up for success
• Medical, Dental, Vision, Life, HSA, 401(k)
• Paid Time Off (PTO)
• 7 paid holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED