Quality Reporting & Compliance Analyst

Avalon Healthcare Solutions; Tampa (FL); On-site; USD 55,000 - 90,000; Full time

Job summary

Avalon Healthcare Solutions is seeking a Quality Support Analyst to support the Quality Department by ensuring accuracy, integrity, and compliance of client-facing reporting and outputs. You will conduct claims research, analyze operational data, and collaborate with internal teams to resolve client inquiries and issues.

The role requires strong analytical skills, meticulous attention to detail, and the ability to manage multiple priorities in a data-driven environment in a Tampa, FL setting.

Qualifications

• Experience in health plan or healthcare services environment.
• Strong analytical and problem solving skills with the ability to manage shifting priorities.
• Proven ownership and accountability for deliverables and outcomes.
• Excellent written and verbal communication with attention to detail in documentation.
• Working knowledge of SQL for developing and executing queries.
• Advanced proficiency in Microsoft Excel.
• Strong organizational skills and attention to detail.

Responsibilities

• Serve as a subject matter expert for quality standards and reporting integrity, ensuring client-facing deliverables meet established guidelines and compliance requirements.
• Perform quality assurance reviews to validate accuracy, completeness, and appropriate data inclusion in reports and deliverables.
• Ensure adherence to reporting standards, including proper use of data filters, correct date ranges, and exclusion of restricted or inappropriate data elements.
• Run and analyze Universe at Risk (UAR) reports.
• Evaluate findings using established thresholds to determine client-reportable issues versus internal maintenance updates.
• Assess findings and determine appropriate classification of issues (Level I, Level II, or Level III) based on established reporting thresholds.
• Escalate Level III issues to the appropriate team or role for further review and resolution.
• Prepare and validate Impact Reports and maintain documentation related to plan changes and reporting outcomes.
• Support service reliability processes by managing issue tracking, maintaining reporting workflows, and coordinating peer reviews.
• Track and manage tickets, determine issue classification levels, estimate resolution timelines, and communicate delivery schedules with Client Service Delivery.
• Upload finalized reports and documentation to internal systems (e.g., JIRA) for distribution and tracking.
• Develop and execute client-specific queries using SQL and Excel to generate internal, monthly, quarterly, and ad hoc reports.
• Conduct claims research and evaluate disputed claims to identify system configuration, processing, or contractual issues.
• Identify operational inaccuracies or trends and support issue resolution through cross-functional collaboration.
• Recommend process improvements to enhance reporting accuracy, quality oversight, and operational efficiency.
• Support special projects and research assignments as needed.

Skills

Ownership

Analytical thinking

Communication

Problem solving

Attention to detail

Documentation

Organizational skills

Tools

SQL

Excel

JIRA

Tableau

Job description

Avalon Healthcare Solutions is seeking a Quality Support Analyst to support the Quality Department by ensuring accuracy, integrity, and compliance of client-facing reporting and outputs. You will conduct claims research, analyze operational data, and collaborate with internal teams to resolve client inquiries and issues.

The role requires strong analytical skills, meticulous attention to detail, and the ability to manage multiple priorities in a data-driven environment in a Tampa, FL setting.