Evry Health · 1 day ago
Healthcare Claims Quality Analyst
United States
Full-time
Remote
Mid Level
3+ years expEvry Health is seeking a Healthcare Claims Quality Analyst to support their claims operations team. The role involves performing in-depth audits of medical claims processing to ensure payment accuracy and compliance with healthcare regulations.
HealthcareWellnessProperty & Casualty InsuranceHealth InsuranceHealth CareInsurancePersonal Health
Responsibilities
In collaboration with the VP of Operations, develop/formalize the audit program, including the appropriate statistical sample size, quality results report, employee scorecard, error taxonomy, etc
Perform a wide range of quality responsibilities aimed at maintaining service excellence and driving continuous improvement in claim accuracy
Become a subject matter expert in medical claims adjudication and claims processing guidelines to evaluate Claims Analyst performance and payment accuracy
Propose documentation updates, workflow improvements, or changes to enhance the claims processing experience
Report on trends and training opportunities
Report out results to the employee and summarize weekly performance into monthly results
Follow up on errors to ensure claims are corrected prior to check run
Develop a rebuttal process to ensure errors are appropriately assigned
Create monthly KPI report that summarizes results, top error trends and recommendations for closing any gaps
Qualification
Required
Minimum of 3-5 years commercial health plan experience
2-3 years' experience performing claims auditing or quality review functions
Expertise in medical claims adjudication and healthcare claims processing
Familiarity with healthcare compliance requirements and claim processing regulations
Solid knowledge of medical and insurance industry terminology
Excellent communicator, both verbally and in writing
Ability to articulate and communicate complex topics to a broad audience
Comfortable in a fast-paced, deadline-oriented work environment
Strong attention to detail and problem-solving skills with a high level of accuracy
Ability to express new ideas or suggestions for improving processes
Skilled at identifying and implementing tools to improve the claims quality assurance process
Collaboration with and support for business and operational units across the organization
Proficient in Microsoft Office applications Word, Excel, Outlook, OneNote, etc
Prior experience using a CRM, preferably Salesforce
Must reside in the United States and in the Eastern or Central time zone
Required to have a dedicated work area established that is separate from other living areas and provides information privacy
Ability to keep all company sensitive documents secure
Must live in a location that receives an existing high-speed internet connection/service
Benefits
Comprehensive health, dental, and vision insurance as well as life and disability
Retirement savings plan with company match
Generous time off/vacation
Professional development opportunities
Flexible and remote work environment
Company
Evry Health
Evry Health makes healthcare affordable and high quality again by providing expanded benefits at an affordable price.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$7.49MKey Investors
Y Combinator
2023-10-13Acquired
2021-06-30Series Unknown· $7.32M
2021-05-14Series A· $0.05M
Leadership Team
Chris Gay
CEO
Jay Startz
COO & Co-Founder
Recent News
Soma Capital
2026-02-13
2026-01-08
Company data provided by crunchbase