Remote Quality Improvement & Claims Research Analyst

Avalon Healthcare Solutions; Tampa (FL); Hybrid; USD 65,000 - 95,000; Full time

Job summary

Avalon Healthcare Solutions is seeking a Quality Improvement Research Analyst to support the Quality Department and client service delivery. The role includes resolving client inquiries, triaging requests, and performing detailed claims research.

You will collaborate cross-functionally to pull claims data and resolve operational issues, ensuring accurate, timely, and proactive service. This position offers remote work with quarterly travel to Avalon’s corporate office in Tampa, Florida, and

Qualifications

• 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.
• Experience in a health plan or healthcare services company is required.
• Solutions-oriented with ownership mindset and continuous improvement.
• Strong written and verbal communication with high attention to detail.
• SQL queries to run client reports.
• Advanced Excel and Microsoft Office proficiency.

Responsibilities

• Serve as Quality SME and support team for service delivery.
• Maintain knowledge of internal processes to resolve inquiries.
• Develop, run, and execute client queries for internal reports.
• Pull and prepare monthly, quarterly, and ad hoc reports for clients.
• Evaluate disputed claims in denial management to facilitate reviews.
• Support resolution of operational inaccuracies and trends.
• Collaborate with Service Delivery and other departments to provide excellent service.
• Identify needs and suggest process improvements.
• Support special assignments and extensive research projects.

Skills

SQL queries

Excel (Advanced)

Communication

Attention to detail

Analytical mindset

Ownership & accountability

Education

Bachelor’s degree preferred; 5+ years relevant experience in lieu of a degree

Tools

JIRA

Job description

Avalon Healthcare Solutions is seeking a Quality Improvement Research Analyst to support the Quality Department and client service delivery. The role includes resolving client inquiries, triaging requests, and performing detailed claims research.

You will collaborate cross-functionally to pull claims data and resolve operational issues, ensuring accurate, timely, and proactive service. This position offers remote work with quarterly travel to Avalon’s corporate office in Tampa, Florida, and