Claims Quality Assurance Specialist

1 day ago


Pasadena, California, United States Conduent State Healthcare, LLC Full time
Job Title: Claims Quality Assurance Analyst

Conduent State Healthcare, LLC is seeking a highly skilled Claims Quality Assurance Analyst to join our team. As a Claims Quality Assurance Analyst, you will play a critical role in ensuring the accuracy and quality of claims processing.

Responsibilities:
  • Monitor and audit access to all internal systems to ensure compliance with company policies and procedures.
  • Conduct audits related to claims, systems, business, and project requirement rules to identify areas for improvement.
  • Monitor projects for defects or potential errors and manage RCA and CAP for the project 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 ensure compliance with company policies and procedures.
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:
  • Flexible working arrangements, including remote work options.
  • 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.
  • Opportunities for career growth and professional development.
  • A dynamic and supportive work environment.

At Conduent State Healthcare, LLC, we value diversity and inclusion and are committed to creating a workplace that is welcoming and inclusive for all employees. We strive to create a culture where you can bring your authentic self to work, grow and thrive, both personally and professionally, and make a difference with our clients, in our communities, and with the millions of people we support.

Pay Transparency Laws in some locations require disclosure of compensation-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. The approximate compensation for this position is $70-85k per year.



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