Claims QA Analyst
The Judge Group Inc.

Orange, California


Location: Orange, CA
Description: The Judge Group is currently seeking a Claims QA Analyst for a fantastic healthcare company in Orange, CA!

This job will have the following responsibilities:

  • The position is responsible for auditing claims activity performed in the Claims department following regulatory and internal guidelines in conjunction with company policies and procedures.
  • This position oversees and implements quality improvement activities from trend reports and works closely with supervisors and trainers to identify training opportunities.
  • This position has analytical, and/or administrative responsibilities specific to the department.
Position Responsibilities:
  • Conducts audit review of claims processed.
  • Audits auto adjudication of claims (system process), programs and carve-outs performed in the claims department (i.e. member billing, reinsurance, etc.).
  • Performs focused audits as needed.
  • Analyzes and reviews QA processing performance indicator reports.
Qualifications & Requirements:
  • High school diploma or equivalent required.
  • 1 years of experience processing professional and facility claims in Managed Care environment required.
  • 1 years of experience in claims auditing claims in a Managed Care Environment highly preferred.
  • Medical Terminology, CPT-4, HCPC, Revenue Codes, and ICD-9.
  • Both Medicare and Medi-Cal billing and claims adjudication experience required.
  • Software experience in Microsoft Excel and Word and experience in with a claims billing system required

If you would be interested to apply, please send your most updated resume to Jacob at jmaybrier@judge.com!

Thank You,

Jacob

Contact: jmaybrier@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com


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