QA Specialist III - Client Success

Accountabilities: The QA Specialist III - Client Success is responsible for delivering advanced quality assurance expertise across complex healthcare payment integrity processes. The role ensures accurate review outcomes, identifies improvement opportunities, and supports operational excellence through collaboration with internal teams and external stakeholders.

Perform advanced quality assurance reviews of highly complex overpayment accounts, applying payer requirements, client-specific guidelines, and quality assurance methodologies.

Analyze overpayment determinations, calculations, and supporting documentation to ensure accuracy, compliance, and alignment with established quality standards.

Serve as a subject matter expert for quality review scenarios, payer requirements, and client-specific processes.

Identify recurring quality trends, operational risks, and process gaps while recommending improvements to increase efficiency and consistency.

Support onboarding, coaching, and knowledge sharing activities for new team members by providing guidance and best practices.

Participate in new client implementations by collaborating with operational leadership, implementation teams, client success teams, and other stakeholders.

Help establish, refine, and maintain quality assurance requirements, methodologies, documentation, and review processes for new and existing clients.

Analyze client communications and implementation discussions to incorporate evolving requirements into quality standards and operational workflows.

Communicate potential risks, ambiguities, and process gaps while ensuring appropriate clarification and resolution.

Maintain up-to-date knowledge of payer guidelines, client expectations, and industry practices through continuous learning and professional development.

Requirements:

The ideal candidate brings strong healthcare knowledge, analytical capabilities, and experience with quality assurance processes. This professional should be detail-oriented, comfortable managing complex reviews, and capable of building strong relationships across teams and with clients.

Bachelor’s degree in business, healthcare, or a related field; equivalent healthcare industry experience may be considered.

Demonstrated experience in healthcare operations, payment integrity, overpayment recovery, or related fields.

Strong understanding of overpayment recovery services and healthcare payer requirements.

Excellent analytical skills with the ability to evaluate complex information and identify trends or risks.

Strong communication and interpersonal skills, with the ability to collaborate effectively with clients, leadership, and peers.

Ability to quickly learn new processes, make an immediate impact, and deliver value-driven solutions.

Strong attention to detail and commitment to accuracy.

Ability to manage priorities and perform effectively under tight deadlines.

Team-oriented mindset with a desire to contribute to organizational growth and continuous improvement.

Benefits:

Competitive compensation package designed to support employee growth and well-being.

Comprehensive health insurance benefits.

401(k) retirement plan with employer match.

Paid parental leave.

Opportunities for professional development and career growth.

Collaborative and innovative work environment.

Supportive culture focused on improving healthcare outcomes.

Opportunities to contribute to meaningful initiatives that reduce healthcare waste and improve access to care.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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