Quality Analyst - Healthcare / Hospital Process

Hiresquad; Mumbai; On-site; INR 675,000 - 825,000; Full time

Job summary

Hiresquad in Mumbai seeks a Quality Analyst (Healthcare Process) to audit prior authorization cases, review clinical documents, and ensure compliance with payer guidelines. The role emphasizes accuracy, calibration, and timely turnaround in a dynamic healthcare QA team.

With at least 1 year in QA for healthcare processes, you will identify gaps, maintain logs and scorecards, and support training using audit insights. On-site Malad location offers up to 7.5 LPA in CTC.

Qualifications

• Strong understanding of prior authorization workflows and payer policies.
• Knowledge of medical terminology and documentation review.
• High attention to detail and analytical skills.
• Effective communication and feedback delivery.

Responsibilities

• Audit prior authorization cases for accuracy, completeness, and adherence to payer guidelines.
• Review clinical documentation and decision rationale for compliance.
• Identify quality gaps and provide clear, constructive feedback to associates.
• Maintain QA logs, scorecards, and trend reports.
• Participate in calibration sessions to ensure scoring consistency.
• Recommend process improvements to reduce errors and improve turnaround time.
• Support training needs based on audit insights.

Skills

Prior authorization workflows

Payer policies

Medical terminology

Attention to detail

Analytical skills

Communication skills

Job description

Were Hiring: Quality Analyst (Healthcare Process)

• Location: Malad (Mumbai)
• Experience: Minimum 1 year as Quality Analyst (Healthcare process)
• Work Mode: 5 Days Working
• CTC: Up to 7.5 Lakhs

Key Responsibilities

• Audit prior authorization cases for accuracy, completeness, and adherence to payer guidelines.
• Review clinical documentation and decision rationale for compliance.
• Identify quality gaps and provide clear, constructive feedback to associates.
• Maintain QA logs, scorecards, and trend reports.
• Participate in calibration sessions to ensure scoring consistency.
• Recommend process improvements to reduce errors and improve turnaround time.
• Support training needs based on audit insights.

Required Skills

• Strong understanding of prior authorization workflows and payer policies.
• Good knowledge of medical terminology and documentation review.
• High attention to detail and analytical skills.
• Effective communication and feedback delivery