Senior Analyst, Provider Quality - Remote

Overview

The Senior Analyst, Provider Quality will act as a liaison between the Quality and Analytics department and various teams to resolve provider issues related to claims payment, ensuring accuracy and compliance with contract terms.

In Short

• Function as the link between Quality and Analytics department and Provider Relations, Network, and Data Quality.
• Distill provider issues related to claims payment problems.
• Act as a subject matter expert on payment terms and contract interpretation.
• Research Provider Data Quality issues resulting in erroneous claims payments.
• Ensure accurate documentation of Policies and Procedures.
• Run ad hoc reports using Excel and other tools.
• Collaborate with Claims and Quality Assurance teams for problem resolution.
• Possess strong written and oral communication skills.
• 5+ years of experience in relevant fields.
• Project management experience preferred.

Requirements

• Bachelor’s degree in health-related field, finance, or business administration.
• 5+ years of experience in claims, provider relations, network development, analytics, or quality assurance.
• Strong Excel skills and communication abilities.
• Experience working independently in a lead role.
• Project management experience is a plus.

Benefits

• Competitive pay and health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules (remote, hybrid, field, or office).