Quality Specialist

Job Title : Specialist – Quality (US Healthcare Claims)

Experience : 4+ years in US Healthcare Claims Adjudication

Qualification : Any Graduate

Job Description :

We are hiring a Quality Specialist with expertise in US Healthcare claims adjudication . The role involves conducting audits, ensuring compliance, identifying errors, and driving process improvements using quality tools and methodologies.

Key Responsibilities :

• Perform quality audits for healthcare claims processing.
• Ensure compliance with client and regulatory requirements (HIPAA, CMS).
• Apply 7 QC tools, RCA, CAPA, and Six Sigma for error reduction.
• Prepare reports and share feedback with operations teams.
• Support process improvement initiatives to enhance accuracy and efficiency.

Mandatory Skills :

Shift : [Rotational Shift]

Education

Bachelor of Science (B.Sc), Bachelor of Commerce (B.Com), Bachelor of Liberal Arts (BLA / ALB), Bachelor of Education (B.Ed), Bachelor of Social Work (B.S.W), Bachelor in General Studies (BGS), Bachelor of Architecture (B.Arch), Bachelor Of Technology (B.Tech / B.E), Bachelor of Interdisciplinary Studies, Bachelor Of Computer Application (B.C.A), Bachelor of Applied Science (BAS), Bachelor of Music Education (B.M.E.), Bachelors of Law (B.L / L.L.B), Bachelor in Hotel Management (B.H.M), Bachelor of Music, Bachelor of Business Administration (B.B.A), Bachelor of Health Science, Bachelor of Arts (B.A), Bachelor Of Pharmacy (B.Pharm)

Skills Required

Us Healthcare, Qc Tools, Capa, Six Sigma, Compliance