Quality specialist For claims adjudication with Sagility

Urgent hiring for Specialist quality for claims adjudication from US Healthcare.

Looking for immediate joiners or less than 30 days' notice period.

Interested folks can reach out to below mentions contact persons.

Quality Analyst Claims Adjudication (US Healthcare)

Experience: 4 years

Location: Indore, Coimbatore, Bangalore

Department: Claims Operations

Role Summary:

Key Responsibilities:

• Conduct audits of adjudicated claims to ensure accuracy, compliance with client guidelines, and US healthcare standards.
• Utilize Six Sigma tools and methodologies for process optimization and efficiency improvement.
• Apply 7 QC tools to analyze defects, identify trends, and improve quality outcomes.
• Perform Root Cause Analysis (RCA) on recurring errors and implement CAPA to eliminate reoccurrence.
• Track and analyze quality performance metrics, prepare audit reports, and share insights with stakeholders.
• Collaborate with operations and training teams to close feedback loops and implement corrective measures.
• Ensure compliance with HIPAA and regulatory guidelines while handling sensitive member/provider data.
• Lead and support continuous process improvement initiatives to enhance accuracy, productivity, and customer satisfaction.

Core Skills:

• Claims adjudication (Medical, Dental, Hospital & Pharmacy claims)
• Quality audits & compliance review
• Six Sigma (Green Belt preferred) & process improvements
• 7 QC tools, RCA & CAPA
• Error trend analysis and quality reporting
• Analytical thinking & problem-solving
• MS Excel, Quality monitoring tools, Workflow management

Interested candidates can please reach out as below:

Anitha or whats app your resume on

Preetham -

Srikanth or whats app your resume on