Claims QA Analyst
The Judge Group Inc.

Orange, California

This job has expired.

Location: Orange, CA
Description: The Judge Group is currently seeking a Claims QA Analyst for a fantastic healthcare company in Orange, CA!

This job will have the following responsibilities:

  • The position is responsible for auditing claims activity performed in the Claims department following regulatory and internal guidelines in conjunction with company policies and procedures.
  • This position oversees and implements quality improvement activities from trend reports and works closely with supervisors and trainers to identify training opportunities.
  • This position has analytical, and/or administrative responsibilities specific to the department.
Position Responsibilities:
  • Conducts audit review of claims processed.
  • Audits auto adjudication of claims (system process), programs and carve-outs performed in the claims department (i.e. member billing, reinsurance, etc.).
  • Performs focused audits as needed.
  • Analyzes and reviews QA processing performance indicator reports.
Qualifications & Requirements:
  • High school diploma or equivalent required.
  • 1 years of experience processing professional and facility claims in Managed Care environment required.
  • 1 years of experience in claims auditing claims in a Managed Care Environment highly preferred.
  • Medical Terminology, CPT-4, HCPC, Revenue Codes, and ICD-9.
  • Both Medicare and Medi-Cal billing and claims adjudication experience required.
  • Software experience in Microsoft Excel and Word and experience in with a claims billing system required

If you would be interested to apply, please send your most updated resume to Jacob at!

Thank You,



This job and many more are available through The Judge Group. Find us on the web at

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