MedReview Inc. · 18 hours ago
Quality Analyst – Data Mining
United States
Full-time
Remote
Senior Level
5+ years expMedReview Inc. is looking for a skilled Quality Analyst to join their Payment Integrity team, specializing in Healthcare Claims Data Mining. The role involves ensuring the quality and accuracy of healthcare claims data, particularly related to post-pay overpayment analysis, and requires collaboration with data analysts and business partners.
Health CareMedicalNon ProfitProfessional Services
Responsibilities
Conduct thorough quality assessments of healthcare claims data, focusing on identifying overpayments through data mining techniques
Develop, implement, and execute quality assurance plans and test cases specific to healthcare claims data mining
Collaborate with data analysts and business partners to analyze claims data for potential overpayments and ensure compliance with client policies
Identify and document any discrepancies or anomalies in claims data, coordinating with cross-functional teams for resolution
Conduct root cause analysis on detected overpayments and develop reports summarizing findings and recommendations for process improvements
Monitor and evaluate data mining processes, providing innovative solutions to enhance data accuracy and quality assurance in healthcare claims
Prepare and present detailed quality assurance reports and metrics to stakeholders, highlighting trends and areas for improvement
Foster strong working relationships with various business partners, ensuring effective communication and collaboration on claims data integrity initiatives
Qualification
Required
High school diploma and or an advanced degree or certifications in Healthcare
Minimum of 5 years of experience in healthcare claims processing, data mining, or related roles, with a specific focus on post-pay overpayment analysis
Proven experience in quality assurance processes and methodologies, particularly in the context of healthcare claims data
Proficiency in O365 applications (Excel, Word, PowerPoint, Teams) for data management and report generation
Strong understanding of healthcare claims regulations, compliance standards, and payment integrity processes
Excellent analytical and problem-solving skills with the ability to interpret complex claims data
Effective communication and interpersonal skills, with experience collaborating with multiple business partners
Experience working with and interpreting medical reimbursement and CMS policy is required
Preferred
Knowledge of coding schemes such as CPT, ICD-10, and HCPCS is beneficial
Company
MedReview Inc.
MedReview is a different type of payment integrity company.
201-500 employees
H1B Sponsorship
MedReview Inc. has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (1)
2022 (6)
Funding
Current Stage
Growth StageLeadership Team
Spencer Young
Chief Executive Officer
Ripal Patel
Chief Financial Officer
Recent News
2025-11-20
2025-08-29
2025-07-23
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