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)
Novus Group • Pittsburgh, PA, US
[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]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. 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. Proven experience and knowledge of reimbursement mechanisms and clinical / procedural coding (e.g., CPT, ICD-10, HCPCS). 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 . 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.
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 :
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 :
Core Competencies and Minimum Qualification Requirements :
Note : Five (5) years of claims processing experience, including commercial and government health insurance plans, may substitute for coding / reimbursement knowledge.
Technical Skills :
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