Claims QA Analyst

Job not on LinkedIn

🕒 May 17

🌾 Nebraska – Remote

🌾 Nebraska – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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Imagenet LLC

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

🛍️ eCommerce

☁️ SaaS

💰 Private Equity Round on 2022-12

Healthcare Insurance • eCommerce • SaaS

Imagenet LLC is a leading provider of business continuity services for healthcare organizations, specializing in digital mailroom solutions, claims adjudication, contact center operations, and workflow management. With over two decades of experience and a reputation for enhancing efficiency and accuracy, Imagenet partners with health plans to streamline processes and improve member satisfaction. Their services are designed to reduce claims turnaround times, increase processing capacities, and lower contact center wait times. By integrating scalable solutions tailored to specific needs, Imagenet enables healthcare organizations to accelerate productivity and mitigate operational challenges.

📋 Description

• Perform detailed audits of denied, underpaid, and processed claims using EZCap to assess accuracy and compliance with provider contracts and regulatory guidelines. • Analyze provider disputes for patterns or recurring issues. • Identify root causes and work with relevant teams to implement corrective actions and process improvements. • Develop and track performance related to claims accuracy, turnaround time, and dispute resolution efficiency. • Conduct thorough root cause analyses on high-impact errors or escalations. • Support training initiatives by identifying knowledge gaps and assisting in the development of updated procedures and documentation based on audit results. • Ensure all reviewed processes align with applicable regulatory requirements. • Participate in internal and external audits as needed.

🎯 Requirements

• High school diploma or equivalent • At least 3-5 years of Quality Analyst in healthcare, TPA, or health plan settings/ healthcare claims or in a claims processing/adjudication environment • Hands-on experience with EZCap (strongly preferred) • Familiarity with Medi-Cal and Commercial insurance claim • Strong analytical and problem-solving skills • Excellent verbal and written communication • Attention to detail in documentation and compliance • Ability to manage multiple tasks and meet deadlines • Experience with other claim adjudication platforms and provider systems • Familiarity with DHCS, DMHC, CMS dispute handling regulations.

🏖️ Benefits

• Remote work offered • Equipment provided • Paid training to set you up for success • Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k) • Paid Time Off (PTO) • 7 paid holidays • A supportive team and a company that values internal growth