Senior Quality Analyst

MagnaCare

  • Las Vegas, NV
  • Permanent
  • Full-time
  • 28 days ago
  • Apply easily
About the Role
MagnaCare is seeking a Senior Quality Analyst, you will oversee contract and benefit configuration to ensure accurate claims processing and network compliance.Primary Responsibilities
  • Audit system configuration against contract requirements.
  • Identify fee schedule, provider rate, and benefit setup discrepancies.
  • Collaborate with IT and operations to resolve claims configuration gaps.
  • Perform routine and complex audits of claim transactions processed within our Production and QA regions to validate results.
  • Detailed review of internal and external reporting.
  • Support quarterly claim audits and updates.
  • Assess the impact of configuration changes by processing claim adjustments, manual claim entry, void-reissue of payment, etc.
  • Support new client implementations by validating benefits and claims logic were loaded correctly.
  • Develop and prepare reporting results of findings from process audits and testing.
  • Assisting in identifying the root cause of errors inline to system configuration vs manual processing.
  • Help identify solutions for system issues impacting claim processing results.
  • Provide audit feedback to the claim's leadership team when a need for group and/or individual training has been identified.
  • Perform focus audits, create ad hoc reports and summarize results for management and/or client.
Essential Qualifications
  • 5+ years of advanced claims adjudication experience including facility, professional and ancillary claims.
  • Minimum 3 years in auditing of claims adjudication.
  • Working knowledge of medical terminologies and coding a plus
  • Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
  • Experience with building and running SQL queries
  • Problem solving/analysis.
  • Strong organizational skills: ability to effectively prioritize and multitask.
  • MS Office (Word, Excel, Outlook and PowerPoint).
  • Strong analytical aptitudes, communication and comprehension capabilities.
  • Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect, and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed. With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.Powered by JazzHR

MagnaCare