quality specialist

Job Title : Quality Specialist – US Healthcare Claims Adjudication

Location : Indore

Experience Required : Minimum 3.5+ years in US Healthcare Claims Adjudication

Job Summary :

We are seeking an experienced and detail-oriented Quality Specialist with expertise in US Healthcare Claims Adjudication . The ideal candidate will be responsible for conducting audits, ensuring compliance, enhancing accuracy in claims processing, and driving process improvements through quality tools and methodologies.

Key Responsibilities :

• Perform audits of healthcare claims adjudication to ensure accuracy, compliance, and adherence to policies.
• Identify process gaps, recommend corrective actions, and track implementation for continuous improvement.
• Utilize 7 QC tools, Root Cause Analysis (RCA), Corrective & Preventive Actions (CAPA), and Six Sigma methodologies to analyze issues and reduce errors.
• Ensure compliance with US healthcare guidelines, regulations, and organizational standards.
• Provide feedback, training, and support to claims processing teams to enhance quality and performance.
• Develop and maintain reports, dashboards, and metrics to monitor process quality and compliance.
• Collaborate with cross-functional teams to implement quality initiatives and achieve business objectives.

Key Skills & Competencies :

Strong knowledge of US healthcare claims adjudication processes and compliance standards.

Proven experience in auditing, compliance, and quality improvement .

Proficiency in 7 QC Tools, RCA, CAPA, and Six Sigma practices.

Excellent analytical, problem-solving, and process improvement skills.

Strong communication and interpersonal skills.

Ability to work independently as well as part of a team.

Qualifications :

Any degree

Certification in Six Sigma (Green Belt / Black Belt preferred) will be an added advantage.

Interested Apply At - [HIDDEN TEXT] / 9677254444.

Skills Required

Claim Adjudication, Auditing, Compliance, Six Sigma