Quality Assurance Analyst (Claims Auditor)

 QUALITY ASSURANCE ANALYST

Quality, Performance, and Risk Management

Las Colinas, TX

 

CONEXIS, a dynamic, growing company In Las Colinas, sets the standard as the best third party administrator in the nation for employee benefits including COBRA, Section 125, and Section 132 plans.  We offer administration services for thousands of employers, large and small, as well as major health insurance and health care providers and Fortune 500 companies.

 

The Quality Assurance Analyst is responsible for administering the company quality assurance program in accordance with customer and company requirements. The QA Analyst’s functions will include objectives, policies, standards, procedures and guidelines for monitoring, reporting and resolving problems.Compile data using sampling techniques, statistical analysis, problem solving, and system resources for performance of Client Service Level Agreements and internal processes throughout the company.Produce performance reports as necessary. Produce additional reports for trending, root-cause analysis, and business risk assessment.Analyze and interpret data to determine quality of data and to identify root causes.Examine reimbursement claims to determine proper payments.Maintain records and recommend reporting system refinements as appropriate. Perform routine audits as necessary for Service Level Agreements and Performance Guarantees.  Perform end-to-end audits as necessary for quality.Assist in driving continuous improvement for all processes by helping to identify operational and process improvement opportunities.Help to establish and execute document controls and assist in writing of Standard Operating Procedures and or Policies.Assist Director of department with purpose, scope, administration and practice of Quality Assurance, Performance, and Risk as assigned.

 

REQUIREMENTS

The Quality Assurance Analyst is required to have training and/or knowledge in the following

areas:

Ø Within first 90 days, must be able to attend and pass required assessments in knowledge of federal and state COBRA, HIPAA and §125 requirements;

Ø Assessment techniques of examining, questioning and evaluating, and continuous improvement

Ø Ability to problem-solve and to meet time constraints of reporting deadlines.

Ø Ability to read and understand technical and non-technical documents as related the position.  This includes the ability to interface with both technical and non-technical personnel. 

Ø Detail oriented, organized, able to work independently or with a group;

Ø Able to use Quality Tools to define problems, collect data, establish facts and draw valid conclusions

 

  Prefer candidate with a college degree, but will consider experience in Quality  field.  Quality Assurance or statistical analysis experience preferred.  Proficient user of Microsoft Excel, Word, and Outlook.  Experience in Administrative Health Care systems, Flexible Spending Accounts, or Insurance industry a plus.

 

We offer excellent benefits including medical, dental, life insurance, paid vacation and holidays, and 401(k) plan.

 





CONEXIS  6191 North State Highway 161 - Suite 400 Irving, TX 75038  www.conexis.com