Quality Improvement Analyst

Yale University; New Haven (CT); Remote; USD 90,000 - 165,750; Full time

Job summary

A leading educational institution is seeking a Quality Improvement Analyst to enhance claims processing and ensure compliance. This remote position requires a Bachelor's degree and over 5 years of relevant experience. The analyst will identify discrepancies, audit claims transactions, and provide valuable insights to improve claims operations. Candidates should be skilled in medical terminology, SQL, and Microsoft Office with excellent communication and analytical abilities. The position offers a competitive salary range and full-time hours.

Qualifications

• Bachelor's degree with a minimum of 5 years of claims adjudication experience.
• Experience in auditing claims adjudication is required.
• Strong communication and negotiation skills are essential.

Responsibilities

• Audit system configuration against provider contracts.
• Identify discrepancies in fee schedules and provider rates.
• Collaborate with IT to resolve claims gaps.
• Prepare reports from audits and testing.
• Participate in quarterly claims audits.

Skills

Medical terminology understanding

Claims processing experience

Excellent communication skills

SQL query proficiency

Microsoft Office skills

Analytical skills

Education

Bachelor's degree

Tools

SQL

Microsoft Office

Job description

Overview

In 1971, Yale University established Yale Health to provide health services to its faculty, staff and students through a multidisciplinary health maintenance organization located on campus. Yale Health has more than 49,000 members including students, staff, faculty and their families who come from every state in the country and almost every country in the world. Our state-of-the-art facility at 55 Lock Street, is where our members receive most of their care from our 150+ providers. It is a 144,000 square foot medical facility with over 90 exam rooms, an Acute Care Department, a 15-bed inpatient facility with two negative pressure rooms, a diagnostic imaging suite including MR and CT scan, x-ray and ultrasound and a full-service retail pharmacy. Yale Health is seeking a Quality Improvement Analyst who will collaborate with operational leaders to ensure accurate claims processing and network compliance. This is a remote role. The Quality Improvement Analyst promotes quality claims management by collaborating with other leaders to detect improvement opportunities and implement corrective actions.

Salary

Salary Range: $90,000.00 - $165,750.00

Schedule

Full-Time – 37.5 HRS, Monday - Friday, 8:30 a.m. – 5:00 p.m. EST. Occasional evenings, weekends or holidays/recess may also be required.

Details

This is a 2-year Fixed Duration, remote position

Required Skills And Abilities

• Working knowledge of medical terminologies and coding, proven experience in a claim's environment, and understanding of HIPAA Confidentiality laws.
• Excellent written and oral communication, interpersonal, and negotiation skills with a demonstrated ability to prioritize tasks as required. Demonstrated problem-solving/analysis skills.
• Proven experience building and running SQL queries. Demonstrated experience with Microsoft Office (Word, Excel, Outlook, and PowerPoint).
• Strong analytical aptitudes, communication, and comprehension capabilities.
• Enthusiastic attitude, cooperative team player and demonstrated ability to adapt to new or changing circumstances.

Principal Responsibilities

• Audit system configuration against provider contract requirements.
• Identify fee schedule, provider rate, and benefit setup discrepancies.
• Collaborate with IT and operations to resolve claims configuration gaps.
• Perform routine and complex audits of claim transactions processed within our Production to validate results and communicate exceptions.
• Detailed review of internal and external reporting.
• Support quarterly claim audits and updates.
• Assess the impact of configuration changes by processing claim adjustments, manual claim entry, void-reissue of payment, etc.
• Support new claims adjudication by validating benefits and claims logic were loaded correctly.
• Develop and prepare reporting results of findings from process audits and testing. Assisting in identifying the root cause of errors inline to system configuration vs manual processing.
• Assist in drafting reimbursement policies.
• Support network assessment and gap identification.
• Help identify solutions for system issues impacting claim processing results.
• Provide audit feedback to the claim's leadership team when a need for group and/or individual training has been identified.
• Perform focus audits, create ad hoc reports and summarize results for management and/or client.
• Perform other duties as assigned in support of effective, efficient operations related to provider contracting and reimbursement.

Required Education And Experience

Bachelor’s degree and a minimum of 5 years of advanced claims adjudication experience including facility, professional and ancillary claims; and a minimum of 3 year’s experience auditing of claims adjudication.

Posting Date

01/23/2026

Job Category

Professional

Bargaining Unit

NON

Compensation Grade

Administration & Operations

Compensation Grade Profile

Manager; Program Leader (M6)

Time Type

Full time

Duration Type

Staff Fixed Duration (Fixed Term)

Work Model

On-site

Location

55 Lock Street, New Haven, Connecticut

Background Check Requirements

All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.

Health Requirements

This role is a healthcare worker position. Healthcare workers (HCW) are defined as university employees working a healthcare setting who have the potential for direct or indirect exposure to patients, human research subjects or infectious materials including body substance, contaminated medical supplies, devices and equipment, surfaces, or air. HCW have specific health requirements that must be met prior to starting work, including MMR vaccine or immunity, varicella (chickenpox) vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination.

Posting Disclaimer

Salary offers are determined by a candidate’s qualifications, experience, skills, and education in relation to the position requirements, along with the role’s grade profile and current internal and external market conditions. The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the position. Employees will be assigned specific job-related duties through their hiring department. The University is committed to basing judgments concerning the admission, education, and employment of individuals upon their qualifications and abilities and seeks to attract to its faculty, staff, and student body qualified persons from a broad range of backgrounds and perspectives. In accordance with this policy and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual’s sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran.

Note

Yale University is a tobacco-free campus.