Quality Assurance Analyst

Raphael & Associates · United States · 1 wk ago

RemoteRemoteEducationFull-time

About the role

Raphael & Associates is a globally recognized third-party claims administrator and independent claims adjusting firm, known for delivering exceptional service. We understand the importance of staying agile in a dynamic market and pride ourselves on tailoring our solutions to meet the unique needs of each client.

Opportunity

The QC Analyst supports quality assurance, compliance, and continuous improvement efforts by conducting internal audits, supporting external audit activities, and helping enhance auditing systems and processes.

Support the ongoing development, maintenance, and enhancement of the organization’s internal auditing platform, including identifying system improvements, testing updates, and optimizing audit workflows.
Conduct comprehensive audits of claim examiners to evaluate adherence to company policies, quality standards, and applicable regulatory requirements, while identifying areas of risk and opportunities for improvement.
Serve as a primary liaison between clients, third-party vendors, and internal stakeholders to coordinate external audit activities, ensuring timely communication and efficient audit execution.
Collect, review, organize, and submit audit-related documentation to support external audits, ensuring accuracy, completeness, and compliance with established requirements.
Collaborate with cross-functional teams to analyze operational processes, identify opportunities for increased efficiency and compliance, and assist in developing and documenting standardized procedures and best practices.
Partner with Training, Legal, and Human Resources departments on special projects, compliance initiatives, policy implementation efforts, and other organizational priorities to support regulatory and business objectives.

Qualifications

10+ years of experience in claims, insurance, quality assurance, and client-facing roles, preferably within a Third-Party Administrator (TPA) environment.
Bachelor’s degree preferred; equivalent professional experience will be considered.
Advanced proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint).
Demonstrated experience with internal, client, and regulatory audits, including DOI complaint responses.
Working knowledge of licensing requirements, Medicare compliance, and other regulatory frameworks.

Competencies

Strong organizational skills and exceptional attention to detail.
Experience with CRM systems and database management.
Customer-focused mindset with a commitment to high-quality client service.
Excellent written and verbal communication skills with a professional presence.
Effective time management skills with a proven ability to meet deadlines and follow through on commitments.
Collaborative team player with the ability to build strong working relationships.
Analytical thinker with strong problem-solving skills and adaptability in a fast-paced environment.

Benefits and Perks

Competitive compensation and benefits package commensurate with experience, including base salary, performance-based incentives, paid time off, comprehensive medical, dental, vision, and life insurance, as well as a 401(k) plan with company matching.
Raphael & Associates is an Equal Opportunity Employer. We are committed to building an equitable, collaborative and diverse workforce throughout our organization by providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other legally protected characteristic.