450 senior clinical quality analyst jobs found

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies....

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies....

The Repricing Quality Assurance Analyst is responsible for reviewing, analyzing, and monitoring repricing audit data across multiple platforms to ensure accuracy, compliance, and efficiency. Works closely with internal teams to maintain contractual and organizational standards, enhance operational effectiveness, and improve client satisfaction. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify and resolve quality issues within repricing processes Develop and implement QA policies and procedures Monitor compliance with pricing guidelines and contractual requirements Investigate repricing discrepancies and apply corrective actions Prepare QA reports and documentation Collaborate with stakeholders to align quality objectives Provide training and guidance on repricing standards Conduct risk assessments to mitigate potential errors Maintain confidentiality of client data, PHI, and PII Additional duties as assigned...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

The Setup Team Lead is responsible for assisting and supporting the Setup Supervisor with ensuring the Setup Team meets protocol. This role will assist with supervisory functions when the Setup Supervisor is absent. The Setup Team Lead is responsible for ½ production. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Must maintain ½ production quota Organize and distribute claims according to established priority Provide guidance to analysts, aiding with resolution of problems or questions Process complex/problematic claims according to protocol Maintain production standards and production requirements Comply with standard protocol for processing problem claims Function as liaison between analysts and clients Professionally communicate with other offices and internal departments Train new team members Assist co-workers, supervisor and management in accomplishing production goals Maintain HIPAA compliance in all aspects of...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned KNOWLEDGE & SKILLS: Ability to work independently...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned KNOWLEDGE & SKILLS: Ability to work independently...

Come join one of America’s fastest-growing insurance companies. Since 1848, National Life Group has aimed to keep our promises, providing families with stability in good times and in bad. Throughout that history, we have provided peace of mind to those families as they plan their futures. Our mission extends beyond the insurance and annuities policies that we offer. We strive to make the world a better place through our grants from our charitable foundation, paid volunteer time for our employees, environmentally sustainable and healthy workplaces, and events that promote the work of nonprofits in our own backyard. We foster a collaborative environment with opportunities for growth and encourage our associates to live our values: Do good. Be good. Make good. Role Summary Please note that we do not offer visa sponsorship for this position. The Actuarial Innovation team is a forward-looking group focused on advancing actuarial capabilities through modern data,...

Overview Join an amazing team that is consistently recognized for our achievements and culture, including our most recent Forbes award of being one of America's Best Midsize Employers for 2026!   This role will lead our customer portal experience for Mercury policyholders on both web and mobile platforms.     Position Summary:   This role's main responsibility will be to manage the product roadmap for identified areas by defining and delivering the next generation of insurance services. Will not only develop innovative product solutions but also execute strategic go-to-market plans and cultivate essential business relationships to seize market opportunities. Responsibilities for this role encompass managing the product roadmap, providing mentorship to junior product managers, nurturing vendor relationships, and fostering cross-domain collaboration. The role also entails ensuring that product direction aligns seamlessly with organizational objectives....

Location: Van Wert, OH; Dublin, OH Work Model: Hybrid Position type: Full time - salary       We’re a team of employees passionate about delivering best-in-class customer service and innovation in the industry. Integrity, relationships, and excellence are at the heart of everything we do. Our employees fully utilize their talents and bring their best selves to work. We believe who you are is just as important as what you do! Delivering exceptional, reliable policy experiences requires more than strong systems, it demands thoughtful, end-to-end ownership of how technology supports customers and the business. We’re looking for a Senior Software Engineer to join our Personal Lines PolicyOps team, where you’ll play a key role in helping us achieve our milestones for implementing and improving the future of our Policy Administration technology stack at Central Insurance. This is an opportunity to shape modern, resilient...

Description If you are passionate about data analytics engineering and want an opportunity to work with the latest technologies, then Modeling Data Solutions has the position for you.   Modeling Data Solutions is seeking experienced data analytics engineers to join its personal lines auto teams. This is an exciting opportunity to join the US Data Science Infrastructure department helping to support creating cutting edge pricing programs. You will play a critical role in designing and developing the data solutions needed for research and development as well as providing front line data support in launching new products into market. You will collaborate with multiple stakeholders including data scientists and product analysts to gather requirements, design, and implement robust data solutions. **This role may have in-office requirements dependent upon candidate location.**   Responsibilities Lead the development, optimization, and maintenance of scalable...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated Bank Credit Risk Analyst, you will use quantitative methods to identify credit risk, develop and deliver credit strategies, and monitor credit performance for consumer credit portfolios to optimize profitable growth within risk appetite. Mitigate operational and compliance risk inherent in credit strategy. Track...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity We are seeking a self-motivated, inspirational project management leader to lead our team of dynamic project delivery managers ​in the delivery of a ~$150M - $200M capital ​plan. This leader would be responsible for the strategic design, operational leadership, and coordination of engineering, design, and construction...

Overview We are seeking a highly skilled product analyst with expertise in writing and optimizing business rules to join our dynamic Product team. In this role, you will design, implement, and maintain business logic within our rules engine applications, ensuring efficiency, scalability, and accuracy. You will work closely with product managers, analysts, and other developers to translate business requirements into high-quality, maintainable C# code.   Collaborate closely within Product Management and with key partners in Product Systems, Product Strategy and IT in the formulation and implementation of key business and automation solutions, supporting profit and growth strategies for AmTrust’s Small Commercial multi-line portfolio   A highly qualified candidate will have experience in small commercial underwriting and/or working with rules in a business context. This role may be filled at the Analyst or Sr. Analyst level, depending upon qualifications and...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. #LI-SJ1 Job Description Summary You will serve as the strategic leader for the Professional and Healthcare Programs Portfolio, driving growth, innovation, and disciplined execution across a diverse set of program businesses. You will be responsible for shaping the portfolio’s direction by identifying and cultivating new program opportunities that align with the company’s long-term objectives and market positioning. In this role, you will oversee the...

Are you passionate about being part of a team at a Fortune 100 company with nearly $70 billion in annual sales that delivers extraordinary care to help individuals and businesses prepare for and protect their future? If so, then Nationwide Financial could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. FINRA SIE and Series 6 required at time of application and you will be required to get your Series 63 within 120 days.   It is our intention to fill this role in Columbus, Ohio or Scottsdale, Arizona. However, on occasion, applications from internal candidates working remotely who bring critical industry skills and relevant experience may be considered.  This role does not qualify for employer sponsored work authorization. Nationwide does not participate in the STEM OPT extension program....

As a team member in Finance at Nationwide, a Fortune 100 company with nearly $70 billion in annual sales, the opportunities are endless! Let Nationwide help create your career journey! At Nationwide®, “on your side” goes beyond just words. Our customers are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. This role does not qualify for employer sponsored work authorization. Nationwide does not participate in the STEM OPT extension program.   This position can be staffed remotely for potential applicants with critical industry skills and relevant experience. Internal Compensation Grade: G4 #LI-KD1 Position Overview As a Middle Market Actuary at Nationwide, you will play a key role in driving pricing strategy and profitability for our commercial lines products. This position supports actuarial initiatives across middle market segments, a critical area within our P&C business. In this role,...

Together we fight for everyone’s opportunity for a better financial future. We will do this together — with customers, partners and colleagues. We will fight for others, not against: We will stand up for and champion everyone’s access to opportunities. The status quo is not good enough … we believe every individual and every community deserves access to financial opportunities. We are determined to support both individuals and communities in reaching a better financial future.  We know that reaching this future depends on our actions today. Like our Purpose Statement, Voya believes in being bold and committed to action.  We are committed to a work environment where the differences that we are born with — and those we acquire throughout our lives — are understood, valued and intentionally pursued. We believe that our employees own our culture and have a responsibility to foster an environment where we all feel comfortable bringing our whole selves to work. Purposefully...

Description Summary The Treasury Capital Markets Analyst reports to the Treasury Capital Markets Portfolio Manager and plays a critical role in supporting portfolio strategy, risk management, and balance‑sheet decision‑making across Treasury. This role offers direct exposure to Portfolio Management, Mortgage Servicing Rights (MSR), Repo, and Hedging activities and is designed for a highly motivated, intellectually curious professional who takes ownership of their work and thrives in a technically demanding, fast‑paced environment. Successful candidates are expected to deliver high‑quality analysis, continuously improve processes, and grow into broader responsibility over time. Key Responsibilities Own the production, validation, and continuous improvement of daily, monthly, and quarterly regulatory and analytical reporting used by Portfolio Management, MSR, Repo, and Hedging teams. Build and enhance...