You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a dedicated Claims Quality Analyst responsible for supporting claims accuracy and operational performance through auditing, coaching, training, and process improvement. This role requires the review of claim activities, identification of quality and compliance trends, and delivering actionable feedback to ensure the consistent application of benefit and claims-processing guidelines.

Key Responsibilities

• Audit approximately 100 claims per day for accuracy, completeness, payment determination, documentation, and adherence to applicable guidelines.
• Monitor claims examiner performance and identify recurring errors, trends, and training needs.
• Provide timely feedback, coaching, and one-on-one guidance to claims examiners.
• Develop and deliver new-hire, refresher, and targeted claims training.
• Maintain training materials, job aids, procedures, and workflow documentation.
• Review complex, escalated, and high-dollar claims as needed.
• Conduct quality calibrations to promote consistency across the claims team.
• Prepare monthly KPI and quality reports covering procedural accuracy, financial accuracy, audit results, and performance trends.
• Partner with leadership to identify root causes and implement corrective actions or process improvements.
• Support testing and validation of claims-system changes and new processes.
• Maintain appropriate documentation and protect confidential member and claims information.

Qualifications

• High School Diploma or GED.
• 5+ years of experience in claims processing/adjudication within a TPA (Third-Party Administrator) setting.
• Direct experience auditing claims in TPA operations.
• Associates degree (preferred).
• WLT MediClaims experience (preferred).

Experience

• 5+ years of experience in claims processing/adjudication within a TPA (Third-Party Administrator) setting.
• Direct experience auditing claims in TPA operations.

Additional Requirements

This is a remote position operating on a standard M-F, 9:00 am - 5:00 pm schedule (East Coast Hours).

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients