Claims QA Specialist: Data Integrity & Process Excellence

Inland Empire Health Plans; California (MO); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, and vision insurance

Life and disability coverage

Career development

Job summary

Inland Empire Health Plans is looking for a Claims Specialist Quality Assurance to oversee the integrity of data created and updated by the Claims Processing staff. You will use quality auditing tools, identify training needs, and help define efficient methods for accurate data entry and adjudication.

The role supports IEHP's commitment to quality initiatives like HEDIS, CAHPS, and NCQA Accreditation, with a focus on ensuring accurate claims processing in a managed care setting.

Qualifications

• Two years of experience examining and processing institutional and professional claims.
• Experience with Medicare/Medi-Cal preferred.
• Experience in a managed care environment helpful.

Responsibilities

• Ensure data integrity for all claims processed by staff.
• Utilize quality auditing tools and identify training needs.
• Define efficient methods for accurate data entry and adjudication.

Skills

Quality audits

Data entry accuracy

Claims processing

Communication skills

Education

High school diploma or GED

Tools

Webstrat

Optum

CMS pricing

Job description

Inland Empire Health Plans is looking for a Claims Specialist Quality Assurance to oversee the integrity of data created and updated by the Claims Processing staff. You will use quality auditing tools, identify training needs, and help define efficient methods for accurate data entry and adjudication.

The role supports IEHP's commitment to quality initiatives like HEDIS, CAHPS, and NCQA Accreditation, with a focus on ensuring accurate claims processing in a managed care setting.