Remote Quality Improvement & Claims Research Analyst

First Roles; Oregon; A distancia; USD 65.000 - 95.000; Jornada completa

Descripción de la vacante

Avalon Healthcare Solutions is a national leader in diagnostic intelligence seeking a Quality Improvement Research Analyst to support client service delivery and cross-functional research on claims data.

The role is eligible for remote work with quarterly travel to the Tampa, Florida office. Candidates should have 3+ years in healthcare, a preferred Bachelor's degree, and strong SQL/Excel skills to drive insights and process improvements.

Formación

• 3+ years in a relevant healthcare field such as claims processing, claims coding, customer service, 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.
• Strong documentation, ownership, and communication skills with high attention to detail.

Responsabilidades

• 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.

Conocimientos

Analytical mindset

Ownership & accountability

Communication

Attention to detail

SQL

Educación

Bachelor’s degree preferred

Herramientas

SQL

Microsoft Excel (Advanced)

JIRA

Descripción del empleo

Avalon Healthcare Solutions is a national leader in diagnostic intelligence seeking a Quality Improvement Research Analyst to support client service delivery and cross-functional research on claims data.

The role is eligible for remote work with quarterly travel to the Tampa, Florida office. Candidates should have 3+ years in healthcare, a preferred Bachelor's degree, and strong SQL/Excel skills to drive insights and process improvements.