Quality Support Analyst

Avalon Administrative Services LLC • Tampa, FL

2d • Remote

About The Position

The Quality Support Analyst is an integral member of the Quality Department, supporting the internal operations that enable exceptional client service delivery. This role is responsible for resolution of client inquiries and issues, including triaging requests and conducting detailed claims research. The Quality Support Analyst works cross-functionally to pull claims data, conduct research, and gather insightful information as needed from other departments to understand and resolve operational issues. Ideal candidates are detail-oriented, analytical, and committed to maintaining high standards of quality and consistency in support operations.

This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Requirements

• Previous experience working in a health plan or healthcare services company is required.
• Bachelor’s degree preferred; 5+ years relevant experience in lieu of a degree
• 3+ years’ in a relevant healthcare field – claims processing, claims coding, customer service, and/or account management
• Maintains a solution-oriented, analytical mindset, even when faced with ambiguity or shifting priorities.
• Demonstrates a strong sense of ownership and accountability for outcomes and continuous improvement.
• Open communication and consistent follow up to keep deliverables on track.
• Expert proficiency in written and oral communication skills required with a high attention to detail to documentation.
• Working knowledge of SQL queries to run client reports.
• Expert proficiency in computer skills including Microsoft Office Suite products (Excel advanced a must).
• Attention to detail is critical.

Nice To Haves

• Experience with data analysis tools
• Reporting and JIRA experience is preferred.
• Experience or certification in medical billing and/or medical coding preferred.
• Knowledge of and experience with laboratory medical coding rule and regulations, compliance, reimbursement, and bundling issues.

Responsibilities

• Act as the Quality Subject Matter Expert and support team for service delivery.
• Acquire an in-depth understanding of internal processes to resolve customer inquiries effectively and efficiently.
• Develop, run, and execute client queries for internal reports.
• Pull and prepare monthly, quarterly, and ad hoc reports for assigned clients.
• Evaluate disputed claims in denial management process for system configuration, claims processing, and/or contractual issues to facilitate health plan review of claims.
• Support the resolution of operational inaccuracies and trends.
• Collaborate with the Service Delivery team and other internal departments to provide excellent service.
• Understand departmental needs and recommend process improvements.
• Assist with special assignments and projects that require extensive and thorough research.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level