Quality Specialist (US Healthcare) - Non-Voice

Job Overview:

• We are seeking a detail-oriented and experienced Quality Specialist with a strong background in US Healthcare processes, specifically in claims adjudication.
• This is a non-voice role focused on ensuring accuracy, compliance, and continuous improvement in healthcare claim processing.
• The ideal candidate will bring analytical rigor, process knowledge, and a passion for quality assurance.

Key Responsibilities:

• Conduct audits of healthcare claims to ensure accuracy and compliance with US healthcare regulations and payer guidelines
• Identify trends, errors, and areas of improvement in claims adjudication processes
• Collaborate with operations and training teams to address quality gaps and implement corrective actions
• Prepare and present audit reports, dashboards, and performance metrics
• Maintain documentation of audit findings and follow-up actions
• Support process improvement initiatives and contribute to SOP updates
• Ensure adherence to HIPAA and other regulatory standards.

Skills & Attributes:

• Minimum 3.6 years of experience in US healthcare domain, with at least 1 year as a Quality Analyst
• Strong understanding of claims adjudication workflows and terminologies
• Excellent analytical and problem-solving skills
• Proficiency in MS Excel, audit tools, and reporting platforms
• Ability to work independently in a fast-paced, deadline-driven environment
• Strong written communication skills (non-voice role)
• Familiarity with HIPAA compliance and payer-specific guidelines.

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