Quality Assurance Specialist

Smart Data Solutions LLC; Plano (TX); Hybrid; USD 70,000 - 90,000; Full time

Job summary

A leading data management provider seeks a Quality Assurance Specialist. The role involves analyzing business specifications, conducting audits, and ensuring compliance in the healthcare sector. Candidates should have a Bachelor's degree, at least 3 years of experience, and strong analytical skills. This hybrid position allows 3 days in-office, offering competitive benefits and a collaborative environment.

Benefits

Health insurance

401(k) with company match

Flexible paid time off

Short-term and long-term disability

Qualifications

• Minimum 3 years of experience in quality assurance or auditing within the healthcare industry.
• Proven ability to analyze data effectively to identify trends and discrepancies.
• Experience with Electronic Data Interchange (EDI) is a plus.

Responsibilities

• Analyze business specifications and ensure alignment.
• Conduct in-depth quality audits and provide actionable recommendations.
• Collaborate with developers and stakeholders to enhance product quality.

Skills

Analytical thinking

Attention to detail

Communication

Education

Bachelor’s degree in Business Administration

Healthcare Administration

Tools

Microsoft Office Suite

Job description

Job Description

Job Description

Quality Assurance Specialist

Smart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Quality Assurance Specialist to join our team!

What you’ll be doing?

Duties & Responsibilities:

• Analyze business specifications and requirements; collaborate with clients and internal teams to ensure alignment and provide ongoing support to project.
• Conduct in-depth quality audits of complex transactions based on established audit parameters and criteria.
• Perform quality reviews of administrative operations and support services to ensure compliance and service excellence in client delivery.
• Investigate escalated and complex business process issues to understand transaction flows, identify root causes, and recommend actionable process improvements.
• Identify, document, and track defects or discrepancies uncovered during audits or testing, ensuring timely resolution and closure.
• Collaborate cross-functionally with developers, product managers, and other stakeholders to resolve issues and enhance product and process quality.
• Plan, execute, and oversee audit assessments to ensure adherence to internal policies, external regulations, contractual obligations, and business requirements.
• Lead and facilitate corrective action initiatives to improve operational procedures, drive process efficiency, and enhance accuracy of results.
• Support root cause analyses, maintain a corrective action tracking system, and communicate barriers or risks to leadership and relevant stakeholders.
• Analyze performance data and key metrics to identify trends, highlight critical areas of concern, and escalate issues as needed.
• Perform other duties as assigned.

The duties set forth above are essential job functions for the role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions.

What we’re looking for?

Required Skills & Qualifications:

• Bachelor’s degree in Business Administration, Healthcare Administration, or a related field; equivalent professional experience may be considered in lieu of a degree.
• Minimum of 3 years of experience in quality assurance, auditing, or a related role within the healthcare industry.
• Solid understanding of healthcare industry regulations, standards, and compliance requirements.
• Demonstrated experience conducting internal and external audits, including development of comprehensive audit reports and actionable recommendations.
• Proven ability to analyze data effectively to identify trends, discrepancies, errors, and areas of noncompliance.
• Strong analytical thinking, deductive reasoning, and root cause analysis skills.
• Proficient in Microsoft Office Suite, particularly Excel, Word, and PowerPoint.
• Hands-on experience reviewing and interpreting medical claim forms, including HCFA, CMS-1500, UB-04, and ADA.
• In-depth knowledge of claims processing, prior authorization workflows, denials, and appeals processes.
• Familiarity with medical code sets including ICD-10, HCPCS, CPT, and applicable modifiers.
• Excellent written and verbal communication skills, with the ability to present complex findings clearly and effectively to stakeholders and senior leadership.
• Exceptional attention to detail and the ability to manage multiple priorities and deadlines in a fast-paced environment.
• Ability to work independently with minimal supervision, while also collaborating effectively as part of a cross-functional team.
• Experience with Electronic Data Interchange (EDI), including familiarity with 837/835 files and X12 standards, is a plus.

Location: This role is located in our Dallas office (Plano, TX). This is a hybrid position with 3 days in-office requirements.

Why this is the company for you?

Top Benefits & Perks:

• A company culture that is authentic, innovative, and collaborative! Our most powerful strength is our people! We build impactful solutions for our customers - their success is our success!
• A professional development and growth-oriented workplace
• Generous benefits including, health insurance, short-term, and long-term disability
• 401(k) with a company match to provide a better future in your retirement years
• A flexible environment with a competitive paid time off package; including vacation, holiday, give-back day, and a floating day

Who is Smart Data Solutions?

Smart Data Solutions (SDS) is a technology leader in healthcare process automation and interoperability. As a strategic partner, SDS helps clients digitally transform their operations, delivering tangible value through reduced costs, streamlined workflows, and an improved customer experience. With data, AI, and automation at its core, SDS provides solutions in Digital Mailroom and Data Capture, Clearinghouse, Intelligent Medical Records, Prior Authorization and Claim Operations. Trusted by over 500 clients—including multiple Blue Cross Blue Shield plans, regional health plans, TPAs, providers, and healthcare partners—SDS streamlines complex front, middle, and back-office operations.

Smart Data Solutions is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or other legally protected status.