Remote Health Insurance QA Analyst

Introduction

Join a forward-thinking health insurance organization seeking a sharp, detail-oriented Remote QA Analyst to strengthen our commitment to compliance, accuracy, and operational excellence. In this fully remote role, you will be central in supporting efficient claims processing, streamlining policy operations, and ensuring our systems align with evolving healthcare regulations. This is a unique opportunity to apply your analytical skills meaningfully, where each quality assurance effort contributes directly to member satisfaction and business integrity. We welcome your expertise if you're passionate about remote analytics, healthcare systems accuracy, and continual process improvement.

Key Responsibilities

Audit & Validate Health Insurance Processes

• Perform structured audits of claim submissions, benefits setup, and member eligibility to ensure consistency and accuracy.
• Verify documentation and transactions align with federal and state compliance mandates.
• Identify discrepancies, issue reports, and recommend solutions that mitigate risk.

Collaborate Across Teams

• Interface with cross-functional teams such as compliance officers, IT developers, and claims processors to improve QA standards.
• Participate in remote workshops and process reviews to align QA practices with organizational goals.

Develop QA Protocols

• Create automated and manual test plans reflecting realistic healthcare usage cases.
• Simulate various policy scenarios to ensure our platform can handle complex claim structures and member journeys.

Monitor Compliance Metrics

• Track KPIs tied to claims turnaround, adjudication accuracy, and compliance thresholds.
• Analyze patterns and use data insights to drive continuous operational enhancements.

Document Outcomes & Improvements

• Keep precise records of QA activities, documenting what worked, what failed, and what changed.
• Support training efforts by creating user-friendly guides and testing reports that assist other remote teams.

Investigate & Troubleshoot

• Proactively seek out anomalies within the system and assess underlying causes using structured queries and diagnostic tools.
• Work closely with technology teams to debug and patch systems without disrupting ongoing claims operations.

Tools and Technologies

QA Automation Tools

• Leverage tools like Selenium and Postman to automate repetitive testing scenarios and speed up validation cycles.

Healthcare Platforms

• Familiarity with Epic, Availity, or similar electronic health records and claim adjudication systems.
• Experience in configuring and interpreting healthcare data from payer systems.

Reporting Dashboards

• Build visual dashboards using Tableau or Power BI to monitor performance indicators.
• Present real-time QA summaries and management insights.

Data Handling

• Manipulate and analyze large datasets with Excel’s advanced functions.
• Write and execute SQL queries to validate data integrity across multiple sources.

Workflow Platforms

• Utilize digital task tracking and documentation platforms to organize QA workflows, assign roles, and ensure department transparency.
• Collaborate asynchronously with distributed teams through dynamic project coordination tools.

Qualifications

Education Requirements

• Bachelor’s degree in Healthcare Administration, Information Systems, Public Health, or related technical discipline.

Professional Experience

• At least 3 years in a QA analyst position within the health insurance industry.
• Proven expertise in claims adjudication, policy configuration, and healthcare compliance.

Key Skills

• Strong organizational and investigative skills to isolate quality issues.
• Excellent written communication for clear and concise reporting.
• Ability to work autonomously and contribute in a remote-first environment.
• Skilled in transforming QA results into actionable process improvements.

Preferred Certifications

• Certified Professional in Healthcare Quality (CPHQ) preferred.
• Lean Six Sigma Green Belt or similar process improvement credential.

Work Environment

Remote Work Flexibility

• This remote position allows you to work from any location while maintaining autonomy and a flexible schedule.
• Asynchronous communication is encouraged to support deep work and reduce distractions.

Culture and Collaboration

• Our team believes in a culture of feedback, innovation, and inclusion.
• You will be part of a collaborative environment where your voice and insights are valued.

Mission-Driven Focus

• Every line of code tested and every workflow optimized supports fair and timely healthcare access.
• Be part of a mission to increase transparency, reduce fraud, and enhance patient outcomes through QA excellence.

Growth Opportunities

This position serves as a launchpad for advancement into senior roles in quality assurance strategy, enterprise compliance, or healthcare systems leadership. You can engage with in-house and third-party audits, data governance practices, and regulatory alignment initiatives that directly influence our national health outcomes.

As you grow within the organization, opportunities may emerge in roles such as Quality Strategy Consultant, Claims Optimization Lead, or Risk Management Analyst—each playing a critical role in shaping healthcare delivery frameworks.

We provide structured mentorship, access to premium training materials, and sponsorship to industry-led events. This role is tailored for professionals ready to evolve with the changing landscape of remote healthcare QA.

Compensation and Benefits

Salary

• The annual compensation for this position is $84,339, reflecting our commitment to fair, transparent pay for remote professionals.

Benefits Package

• Comprehensive health insurance plan with dental and vision coverage.
• 401(k) plan with competitive company matching.
• Annual learning & development fund for courses, books, or certifications.
• Robust leave policies, including flexible time off, wellness days, and recognized holidays.
• Monthly remote work allowance for home office equipment or internet upgrades.

Call to Action

We are looking for analytical minds who want their work to matter. We want to hear if you can apply your QA testing, claims auditing, and compliance skills to real-world challenges affecting millions.

Apply today and help us deliver accuracy, trust, and quality to the world of health insurance—one tested process at a time.