Remote Health Insurance QA Analyst

Naukri Mitra; United States; Remote; USD 76,000 - 93,000; Full time

Benefits offered by this job

Health insurance

401k matching

Learning fund

Flexible leave

Remote work allowance

Job summary

Naukri Mitra is seeking a remote Health Insurance QA Analyst to audit claims, benefits setup, and member eligibility while ensuring compliance with federal and state regulations. The role collaborates with compliance, IT, and claims teams to improve QA standards and drive operational excellence in a fully remote setting.

The ideal candidate has 3+ years in health insurance QA, strong analytical and reporting skills, and familiarity with Epic, Availity, and QA automation tools.

Qualifications

• Bachelor’s degree in Healthcare Administration, Information Systems, Public Health, or related field.
• At least 3 years as a QA analyst in health insurance; claims adjudication and policy configuration experience preferred.
• Strong organizational and investigative skills with clear reporting abilities.
• CPHQ certification preferred; Lean Six Sigma Green Belt or similar is a plus.

Responsibilities

• Audit and validate health insurance processes for accuracy and compliance with federal/state mandates.
• Collaborate with compliance, IT, and claims teams to improve QA standards in a remote environment.
• Develop automated and manual test plans; simulate policy scenarios and complex claim structures.
• Monitor KPIs on claims turnaround and adjudication accuracy to drive improvements.
• Document QA outcomes, create guides and testing reports for remote teams.
• Investigate anomalies and troubleshoot with technology teams to patch systems without disrupting operations.

Skills

QA testing

Healthcare compliance

Requirements analysis

Remote collaboration

Education

Bachelor's in Healthcare

Tools

Selenium

Postman

Epic

Availity

Tableau

Power BI

SQL

Job description

Remote Health Insurance QA Analyst Introduction

Join a forward-thinking health insurance organization seeking a sharp, detail-oriented Remote QA Analyst to strengthen our commitment to compliance, accuracy, and operational excellence. In this fully remote role, you will be central in supporting efficient claims processing, streamlining policy operations, and ensuring our systems align with evolving healthcare regulations. This is a unique opportunity to apply your analytical skills meaningfully, where each quality assurance effort contributes directly to member satisfaction and business integrity. We welcome your expertise if you're passionate about remote analytics, healthcare systems accuracy, and continual process improvement.

Key Responsibilities

• Audit & Validate Health Insurance Processes Perform structured audits of claim submissions, benefits setup, and member eligibility to ensure consistency and accuracy. Verify documentation and transactions align with federal and state compliance mandates. Identify discrepancies, issue reports, and recommend solutions that mitigate risk.
• Collaborate Across Teams Interface with cross-functional teams such as compliance officers, IT developers, and claims processors to improve QA standards. Participate in remote workshops and process reviews to align QA practices with organizational goals.
• Develop QA Protocols Create automated and manual test plans reflecting realistic healthcare usage cases. Simulate various policy scenarios to ensure our platform can handle complex claim structures and member journeys.
• Monitor Compliance Metrics Track KPIs tied to claims turnaround, adjudication accuracy, and compliance thresholds. Analyze patterns and use data insights to drive continuous operational enhancements.
• Document Outcomes & Improvements Keep precise records of QA activities, documenting what worked, what failed, and what changed. Support training efforts by creating user-friendly guides and testing reports that assist other remote teams.
• Investigate & Troubleshoot Proactively seek out anomalies within the system and assess underlying causes using structured queries and diagnostic tools. Work closely with technology teams to debug and patch systems without disrupting ongoing claims operations.

Tools and Technologies

• QA Automation Tools Leverage tools like Selenium and Postman to automate repetitive testing scenarios and speed up validation cycles.
• Healthcare Platforms Familiarity with Epic, Availity, or similar electronic health records and claim adjudication systems. Experience in configuring and interpreting healthcare data from payer systems.
• Reporting Dashboards Build visual dashboards using Tableau or Power BI to monitor performance indicators. Present real-time QA summaries and management insights.
• Data Handling Manipulate and analyze large datasets with Excel’s advanced functions. Write and execute SQL queries to validate data integrity across multiple sources.
• Workflow Platforms Utilize digital task tracking and documentation platforms to organize QA workflows, assign roles, and ensure department transparency. Collaborate asynchronously with distributed teams through dynamic project coordination tools.

Qualifications

• Education Requirements Bachelor’s degree in Healthcare Administration, Information Systems, Public Health, or related technical discipline.
• Professional Experience At least 3 years in a QA analyst position within the health insurance industry. Proven expertise in claims adjudication, policy configuration, and healthcare compliance.
• Key Skills Strong organizational and investigative skills to isolate quality issues. Excellent written communication for clear and concise reporting. Ability to work autonomously and contribute in a remote-first environment. Skilled in transforming QA results into actionable process improvements.
• Preferred Certifications Certified Professional in Healthcare Quality (CPHQ) preferred. Lean Six Sigma Green Belt or similar process improvement credential.

Work Environment

Remote Work Flexibility: This remote position allows you to work from any location while maintaining autonomy and a flexible schedule. Asynchronous communication is encouraged to support deep work and reduce distractions.

Culture and Collaboration

Our team believes in a culture of feedback, innovation, and inclusion. You will be part of a collaborative environment where your voice and insights are valued.

Mission-Driven Focus

Every line of code tested and every workflow optimized supports fair and timely healthcare access. Be part of a mission to increase transparency, reduce fraud, and enhance patient outcomes through QA excellence.

Growth Opportunities

This position serves as a launchpad for advancement into senior roles in quality assurance strategy, enterprise compliance, or healthcare systems leadership. You can engage with in-house and third-party audits, data governance practices, and regulatory alignment initiatives that directly influence our national health outcomes. As you grow within the organization, opportunities may emerge in roles such as Quality Strategy Consultant, Claims Optimization Lead, or Risk Management Analyst—each playing a critical role in shaping healthcare delivery frameworks. We provide structured mentorship, access to premium training materials, and sponsorship to industry-led events. This role is tailored for professionals ready to evolve with the changing landscape of remote healthcare QA.

Compensation and Benefits

Salary

$84,339

Benefits Package

• Comprehensive health insurance plan with dental and vision coverage.
• 401(k) plan with competitive company matching.
• Annual learning & development fund for courses, books, or certifications.
• Robust leave policies, including flexible time off, wellness days, and recognized holidays.
• Monthly remote work allowance for home office equipment or internet upgrades.

Building a Global Workforce: Applications are open to professionals from the United States, Canada, United Kingdom, European Union, Australia, India, and many other international regions.