Quality Assurance Specialist - Medical Claims

Datamark•El Paso, TX

About The Position

DATAMARK, Inc. is seeking a detail-oriented Quality Assurance Specialist to help ensure the accuracy, consistency, and compliance of medical claims processing operations. The role evaluates performance, identifies trends, and supports continuous improvement in collaboration with operations leadership, training, and compliance teams. The specialist monitors and audits processor performance, provides feedback and coaching, supports new-hire quality expectations, analyzes and communicates quality metrics, and maintains documentation of audits and corrective actions. The role also supports audit readiness, investigates quality concerns with cross-functional teams, and participates in calibration and quality review meetings.

Requirements

High school diploma or equivalent required.
At least 3 years of quality assurance, quality control, auditing, or process improvement experience.
Experience conducting quality audits, analyzing performance data, and driving process improvement initiatives.
Working knowledge of quality management principles, audit methodologies, and continuous improvement practices.
Strong analytical and problem-solving skills, including the ability to identify trends, root causes, and improvement opportunities.
Excellent written and verbal communication skills, including providing constructive feedback and presenting findings to stakeholders.
Strong attention to detail and ability to maintain accuracy while managing multiple priorities.
Proficiency with Microsoft Excel and reporting tools used to track, analyze, and communicate quality performance metrics.
Ability to collaborate effectively with Operations, Training, and Compliance teams.
Ability to adapt to changing business needs and work effectively in a fast-paced environment.

Nice To Haves

Associate's or bachelor's degree.
At least 1 year of experience in a healthcare, medical claims processing, or related operational environment.
Experience auditing healthcare operations, medical claims processing, eligibility verification, prior authorizations, or related healthcare transactions.
Experience in a business process outsourcing (BPO), customer operations, healthcare services, or similar environment.

Responsibilities

Develop and maintain knowledge of quality expectations, performance standards, policies, procedures, and compliance requirements related to medical claims processing.
Monitor and evaluate processor performance through quality audits and transaction reviews; provide objective feedback and identify improvement opportunities.
Partner with supervisors and operational leaders on performance improvement initiatives and corrective action plans.
Conduct performance-improvement coaching based on quality results.
Assist new-hire classes with quality assurance requirements and expectations.
Analyze quality data and prepare regular reports highlighting trends, risks, and opportunities for process enhancement.
Publish and communicate quality performance metrics to management and project stakeholders regularly.
Maintain accurate records of quality reviews, audit findings, corrective actions, and identified issues.
Support internal and external audit readiness, including documentation reviews and compliance assessments.
Collaborate with Training, Compliance, and Operations teams to investigate quality concerns and implement solutions.
Participate in calibration sessions and quality review meetings to ensure scoring consistency and alignment across teams.