Claims Quality Business Analyst

• Evaluate claims operations for compliance with CMS Medicare Advantage requirements, AHCA requirements, and internal policies.
• Lead implementation of regulatory, benefit, and operational changes affecting RA/EOB content, claims reason codes, remark codes, notices, and member/provider-facing explanations.
• Assist with audit readiness activities, CAP development, and monitoring of corrective actions.

• Partner with IT, Quality, Compliance, Medical Management, Provider Relations, and Member Services teams.
• Participate in operational committees and quality improvement initiatives.
• Assist with provider and internal staff education related to claims processes and regulatory requirements.

Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.   

No Third Party Agencies or Submissions Will Be Accepted.   Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP   Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.