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Quality Assurance Analyst (Insurance Auditor Focus) Pittsburgh, PA 15219 (Downtown)
Quality Assurance Analyst (Insurance Auditor Focus) Pittsburgh, PA 15219 (Downtown)Novus Group • Pittsburgh, PA, US
Quality Assurance Analyst (Insurance Auditor Focus) Pittsburgh, PA 15219 (Downtown)

Quality Assurance Analyst (Insurance Auditor Focus) Pittsburgh, PA 15219 (Downtown)

Novus Group • Pittsburgh, PA, US
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Job Description

Job Description

Quality Assurance Analyst ( Insurance Auditor Focus ) – Pittsburgh, PA 15219 (Downtown)

  • Status : Full-Time
  • Shift : Day Job
  • Work Arrangement : Hybrid (2 days in-office required, 3 days remote)
  • Location : Pittsburgh, PA 15219 (Downtown)
  • Department : Operational Risk Integrity
  • Starting Pay Range : $24.00 - $29.00 per hour as a new hire, based on experience.
  • Compensation increases : After hire and through promotional, performance-based increases, additional compensation can be earned up to $42.00 per hour. Continuous and experiential learning will be required to achieve pay increases.

Comprehensive Benefits Package

The Company offers competitive compensation and a full range of benefits designed to support your total well-being, including :

  • Competitive Pay : Base wages, Merit Pay , and generous Premium Pay (Off-Shift Differential, Holiday Pay, Standby / Call-in Pay).
  • Health & Wellness : Comprehensive Medical, Dental, Vision, and Prescription Drug Coverage , plus Flexible Spending Accounts (FSAs) . Access to Employee Assistance Programs (EAP) and various Wellness Programs (e.g., stress management, weight management).
  • Financial Security & Retirement : Cash Balance and Savings Plans , along with Basic Life, AD&D, and Disability Insurance .
  • Time Off & Leave : Generous Vacation / Personal / Sick Time (PTO) , Paid Holidays, Funeral Leave, and Paid Parental Leave .
  • Professional Growth : Opportunities for Tuition Assistance , access to training resources, and defined Advancement Opportunities via Career Ladders and Internal Job Postings.
  • Work-Life Support : Child and Elder Care Referrals, Legal Insurance, and Employee Discounts / Perks.
  • Recognition : Programs like Merit Awards, ACES, and Service Awards to recognize your valuable contributions.

    • The Quality Assurance Analyst is meticulous and analytical working with the Company’s Operational Risk Integrity department in Pittsburgh, PA. This role functions as a critical Insurance Auditor Analyst , primarily responsible for ensuring the accuracy and integrity of the claim payment systems. This is a full-time, hybrid position, working daylight hours (Monday – Friday), requiring two days per week in our Pittsburgh office.

    Key Responsibilities

    As a core member of the Operational Risk Integrity team, you will :

  • Claim Auditing : Conduct comprehensive prospective and retrospective audits of high dollar claims to verify payment accuracy and adherence to policy.
  • Payment Integrity : Collaborate directly with Reimbursement and Configuration Specialists to identify, investigate, and resolve payment inaccuracies and ensure correct system configuration.
  • Risk Mitigation : Analyze audit results, identify root causes of errors, and detect emerging error trends to recommend policy / procedure modifications and necessary staff training.
  • Process Improvement : Drive continuous improvement by participating in and leading initiatives to target potential problems and enhance operational efficiency.
  • Data Analysis & Reporting : Devise sampling methodologies , retrieve audit samples, and compile / report statistical data to internal stakeholders and external client audit teams.
  • Stakeholder Management : Act as a subject matter expert to resolve complex or difficult issues, ensuring satisfaction for internal (Claims, Customer Service, Marketing) and external customers.
  • Maintain strict confidentiality in all activities.

    • Core Competencies and Minimum Qualification Requirements :

  • Proven experience and knowledge of reimbursement mechanisms and clinical / procedural coding (e.g., CPT, ICD-10, HCPCS).

    • Note : Five (5) years of claims processing experience, including commercial and government health insurance plans, may substitute for coding / reimbursement knowledge.

  • Basic to intermediate understanding of managed care delivery systems .
  • Excellent analytical skills and familiarity with basic statistical analysis.
  • High level of oral and written communication skills for effective reporting and issue resolution.
  • Highly detail-oriented with superior organizational skills .

    • Technical Skills :

  • Intermediate proficiency with Microsoft Excel (e.g., pivot tables, formulas).
  • Intermediate proficiency with general MS Office products .
  • Familiarity with reporting tools like MS Access or COGNOS is a plus.
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