Quality Assurance Specialist - Medical Claims

DATAMARK, Inc. is seeking a detail-oriented Quality Assurance Specialist to join our team. In this role, you will help ensure the accuracy, consistency, and compliance of medical claims processing operations by evaluating performance, identifying trends, and supporting continuous improvement efforts. You will work closely with operations leadership, training, and compliance teams to maintain quality standards and drive operational excellence.ResponsibilitiesDevelop and maintain a thorough understanding of quality expectations, performance standards, policies, procedures, and compliance requirements related to medical claims processingMonitor and evaluate processor performance through quality audits and transaction reviews, providing objective feedback and identifying opportunities for improvementPartner with supervisors and operational leaders to support performance improvement initiatives and corrective action plansAnalyze quality data and prepare regular reports that highlight trends, areas of risk, and opportunities for process enhancementPublish and communicate quality performance metrics to management and project stakeholders on a regular basisMaintain accurate records of quality reviews, audit findings, corrective actions, and identified issuesSupport internal and external audit readiness activities, including documentation reviews and compliance assessmentsCollaborate with Training, Compliance, and Operations teams to investigate quality concerns and implement effective solutionsParticipate in calibration sessions and quality review meetings to ensure scoring consistency and alignment across teamsRequirementsHigh school diploma or equivalent required; associate's or bachelor's degree preferredMinimum of 3 years of quality assurance, quality control, auditing, or process improvement experienceAt least 1 year of experience in a healthcare, medical claims processing, or related operational environment preferredExperience auditing healthcare operations, medical claims processing, eligibility verification, prior authorizations, or related healthcare transactions preferredExperience conducting quality audits, analyzing performance data, and driving process improvement initiativesPrior experience in a business process outsourcing (BPO), customer operations, healthcare services, or similar environment is preferredWorking knowledge of quality management principles, audit methodologies, and continuous improvement practicesStrong analytical and problem-solving skills with the ability to identify trends, root causes, and opportunities for improvementExcellent written and verbal communication skills, including the ability to provide constructive feedback and present findings to stakeholdersStrong attention to detail and ability to maintain accuracy while managing multiple prioritiesProficiency with Microsoft Excel and reporting tools used to track, analyze, and communicate quality performance metricsAbility to collaborate effectively with cross-functional teams, including Operations, Training, and ComplianceAbility to adapt to changing business needs and work effectively in a fast-paced environmentBenefitsHealth Care Plan (Medical, Dental & Vision)Retirement Plan (401k, IRA)Life Insurance (Basic, Voluntary & AD&D)Paid Time Off (Vacation, Sick & Public Holidays)Short Term & Long Term DisabilityTraining & DevelopmentWellness Resources