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Claims Quality Assurance Specialist

2 months ago

Elkridge, Maryland, United States Conduent Full time
Job Description

As a Claims Quality Assurance Analyst at Conduent, you will play a crucial role in ensuring the accuracy and integrity of claims processing. Your responsibilities will include monitoring and auditing access to internal systems, conducting audits related to claims, systems, business, and project requirement rules, and identifying areas for improvement.

Key Responsibilities:
  • Monitor and audit access to all internal systems to ensure compliance with company policies and procedures.
  • Conduct thorough audits of claims, systems, business, and project requirement rules to identify areas for improvement.
  • Identify and address defects or potential errors in projects to ensure timely and accurate delivery.
  • Manage RCA (Root Cause Analysis) and CAP (Corrective Action Plan) for projects during audits.
  • Ensure that documented policies, procedures, and workflows are maintained and up-to-date.
  • Utilize experience with data warehouse to enhance data quality and analysis.
  • Perform outreach and education sessions for Maryland Medicaid Providers to promote compliance and best practices.
Qualifications:
  • Possess a bachelor's degree in information technology, computer science, or a related field.
  • Have a minimum of 3 years of experience in IT Quality Assurance or a related role.
  • Show strong knowledge of Change and Release Management processes.
  • Possess experience with data warehouse and its applications.
  • Demonstrate proficiency with MS Office Suite.
  • Have excellent analytical and problem-solving skills.
  • Exhibit strong communication and interpersonal skills.
  • Show experience with PBM (Pharmacy Benefit Management), Medicaid, and Medicare desired.
  • Able to travel and attend in-person state meetings as required.
What We Offer:
  • A competitive salary range of $70-85k per year.
  • A comprehensive benefits package, including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation or sick time.
  • A flexible work environment that allows you to work from home and maximize your time.
  • A culture that values individuality and provides opportunities for growth and development.

At Conduent, we are committed to creating a culture where you can thrive, make a difference, and be part of a team that values diversity and inclusion. If you are a motivated and detail-oriented individual with a passion for quality assurance, we encourage you to apply for this exciting opportunity.