quality assurance analyst

About the role

Conducts quality assurance reviews of IDRE case processing activities—reviewing case files, eligibility determinations, communications, and determinations for compliance with CMS requirements, accuracy, and PRI quality standards. Supports continuous improvement by documenting findings and tracking corrective actions.

Responsibilities

• Conduct QA reviews of assigned IDRE case files—eligibility determinations, case documentation, and party communications
• Apply CMS IDRE quality standards and PRI quality criteria to assess case file accuracy and compliance
• Document QA findings clearly—identify the issue, the applicable standard, and the required correction
• Track corrective action completion for identified QA findings
• Provide feedback to operational staff and supervisors on identified quality issues
• Generate QA reports on error rates, finding categories, and trends
• Support CMS audit preparation—QA documentation and evidence compilation
• Participate in calibration sessions to ensure consistent QA application across the team

Requirements

• 1 to 4 years of quality assurance or compliance review experience—healthcare or IDRE preferred
• Knowledge of CMS IDRE requirements and No Surprises Act preferred
• Strong analytical skills—identifies patterns and root causes of errors
• Detail-oriented—reads case files carefully and applies standards consistently
• Clear written communication—QA findings must be specific, accurate, and actionable
• Ability to deliver feedback constructively to operational staff