Quality Assurance Analyst

Remote Jobs; Erie (Erie County); On-site; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

Life Insurance

Disability

Health Savings Account (HSA)

Flexible Spending Accounts (FSA)

Critical Illness

Accident

Legal and ID Theft

401k plan

PTO

Job summary

Talentify is seeking a QA professional to conduct quality assurance reviews of IDRE case processing, ensuring CMS requirements, PRI quality standards, and accuracy across case files. You will document findings and track corrective actions to drive continuous improvement.

Ideal candidates have 1–4 years in QA or compliance review, prefer healthcare/IDRE exposure, and can deliver clear, actionable feedback. The role supports CMS audit prep and calibration sessions to ensure consistent QA

Qualifications

• 1–4 years of quality assurance or compliance review experience; healthcare or IDRE preferred.
• Knowledge of CMS IDRE requirements and No Surprises Act preferred.
• Strong analytical skills; identifies patterns and root causes of errors.
• Detail-oriented; reads case files carefully and applies standards consistently.
• Clear written communication; QA findings must be specific, accurate, and actionable.

Responsibilities

• Conduct QA reviews of assigned IDRE case files—eligibility determinations, case documentation, and party communications.
• Apply CMS IDRE quality standards and PRI quality criteria to assess case file accuracy and compliance.
• Document QA findings clearly—identify the issue, the applicable standard, and the required correction.
• Track corrective action completion for identified QA findings.
• Provide feedback to operational staff and supervisors on identified quality issues.
• Generate QA reports on error rates, finding categories, and trends.
• Support CMS audit preparation—QA documentation and evidence compilation.
• Participate in calibration sessions to ensure consistent QA application across the team.

Skills

Quality assurance

Compliance review

CMS IDRE requirements

No Surprises Act

Analytical skills

Detail-oriented

Written communication

Feedback delivery

Job description

Job description

Position summary Conducts quality assurance reviews of IDRE case processing activities - reviewing case files, eligibility determinations, communications, and determinations for compliance with CMS requirements, accuracy, and PRI quality standards. Supports continuous improvement by documenting findings and tracking corrective actions.

Essential functions

• Conduct QA reviews of assigned IDRE case files - eligibility determinations, case documentation, and party communications
• Apply CMS IDRE quality standards and PRI quality criteria to assess case file accuracy and compliance
• Document QA findings clearly - identify the issue, the applicable standard, and the required correction
• Track corrective action completion for identified QA findings
• Provide feedback to operational staff and supervisors on identified quality issues
• Generate QA reports on error rates, finding categories, and trends
• Support CMS audit preparation - QA documentation and evidence compilation
• Participate in calibration sessions to ensure consistent QA application across the team

Minimum qualifications

• 1 to 4 years of quality assurance or compliance review experience - healthcare or IDRE preferred
• Knowledge of CMS IDRE requirements and No Surprises Act preferred
• Strong analytical skills - identifies patterns and root causes of errors
• Detail-oriented - reads case files carefully and applies standards consistently
• Clear written communication - QA findings must be specific, accurate, and actionable
• Ability to deliver feedback constructively to operational staff

As an EEO/Affirmative Action Employer all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status.

Benefits and Compensation

Provider Resources provides a competitive benefits package that includes access to Medical, Dental, and Vision Insurance, Life Insurance, Disability, Health Savings Account (HSA), Flexible Spending Accounts (FSA), Critical Illness, Accident, Legal and ID Theft, 401k plan, PTO.

• Medical, Dental, and Vision Insurance
• Life Insurance
• Disability
• Health Savings Account (HSA)
• Flexible Spending Accounts (FSA)
• Critical Illness
• Accident
• Legal and ID Theft
• 401k plan
• PTO

The anticipated salary range for fully qualified candidates applying for this role will be above (not including discretionary bonus, equity, and benefits). The final salary offered will be dependent on several factors that include but are not limited to relevant previous experience including duration and type of experience within the industry, education, and internal equity.