Quality Improvement Research Analyst

Avalon Administrative Services LLC; Tampa (FL); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Avalon Healthcare Solutions is seeking a Quality Improvement Research Analyst to support the Quality Department with client inquiries, claims research, and cross‑functional data analysis. The role involves developing client reports, evaluating disputed claims, and driving process improvements.

The ideal candidate has 3+ years in healthcare, strong SQL and Excel skills, and excellent communication. Remote work is allowed with quarterly travel to Tampa, FL.

Qualifications

• Minimum 3+ years in a relevant healthcare field – claims processing, claims coding, customer service, and/or account management
• Bachelor’s degree preferred; 5+ years relevant experience in lieu of a degree
• Previous experience working in a health plan or healthcare services company is required
• Excellent communication and ability to maintain attention to detail with documentation

Responsibilities

• Act as the Quality Subject Matter Expert and support team for service delivery.
• Resolve client inquiries by understanding internal processes and providing timely responses.
• Develop, run, and execute client queries for internal reports.
• Pull and prepare monthly, quarterly, and ad hoc reports for assigned clients.
• Evaluate disputed claims in denial management to facilitate health plan reviews.
• Support the resolution of operational inaccuracies and trends.
• Collaborate with Service Delivery and other internal departments to provide excellent service.
• Understand departmental needs and recommend process improvements.
• Support special assignments and research projects.

Skills

SQL

Excel

Communication

Analytical thinking

Documentation

Team collaboration

Education

Bachelor's degree

Tools

JIRA

Reporting tools

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Quality Improvement Research Analyst

Full Time 2D Tampa, FL, US

2 days ago Requisition ID: 1206

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Quality Improvement Research Analyst Position:

The QI Research Analyst is a key member of the Quality Department, supporting the internal operations needed for stellar client service delivery. This position is responsible for resolution of client inquiries and issues, including triaging requests and conducting detailed claims research. The QI Research Analyst works cross-functionally with other departments to conduct research, pull claims data, and obtain information as needed from other departments to understand and resolve operational issues.

This position is eligible for remote work, but quarterly travel will be required to Avalon’s corporate office located in Tampa, Florida.

Quality Improvement Research Analyst – Essential Functions and Responsibilities:

• Act as the Quality Subject Matter Expert and support team for service delivery.
• Maintain in-depth knowledge of internal processes to effectively resolve customer inquiries.
• Develop, run, and execute client queries for internal reports.
• Pull and prepare monthly, quarterly, and ad hoc reports for assigned clients.
• Evaluate disputed claims in denial management process for system configuration, claims processing, and/or contractual issues to facilitate health plan review of claims.
• Support the resolution of operational inaccuracies and trends.
• Collaborate with Service Delivery team and other internal departments to provide excellent service.
• Understand departmental needs and recommend process improvements.
• Support special assignments and projects that require extensive and thorough research.

Quality Improvement Research Analyst – Minimum Qualifications:

• Minimum years of relevant work experience: 3+ years’ in a relevant healthcare field – claims processing, claims coding, customer service, and/or account management
• Minimum education: Bachelor’s degree preferred; 5+ years relevant experience in lieu of a degree
• Required certification: n/a
• Previous experience working in a health plan or healthcare services company is required.
• Maintains a solutions-oriented, analytical mindset, even when faced with ambiguity or shifting priorities.
• Demonstrates a strong sense of ownership and accountability for outcomes and continuous improvement.
• communication and consistent follow up to keep deliverables on track.
• Expert proficiency in written and oral communication skills required with a high attention to detail to documentation.
• Working knowledge of SQL queries to run client reports.
• Expert proficiency in computer skills including Microsoft Office Suite products (Excel advanced a must).
• Attention to detail is critical.

Quality Improvement Research Analyst – Preferred Qualifications:

• Experience with data analysis tools
• Reporting and JIRA experience is preferred.
• Experience or certification in medical billing and/or medical coding a plus.
• Knowledge of and experience with laboratory medical coding rule and regulations, compliance, reimbursement, and bundling issues.