Claims QA Administrator

The Claims QA Administrator supports the timely and accurate handling of claims-related system activities to help ensure efficient and seamless department operations. This role assists with daily operational needs by managing and handling incoming helpdesk tickets, coordinating requests, and supporting testing and quality assurance efforts related to claims systems.

Job Responsibilities:

• Serve as a liaison between claims business stakeholders and claims system development/support teams to facilitate clear communication of requests, requirements, and system updates
• Coordinate and support User-Acceptance-Testing efforts for claims system enhancements, fixes, and integrations, including assisting with test planning, execution, and documentation
• Monitor, triage, and respond to incoming claims system helpdesk tickets; resolve routine issues independently and escalate complex issues as appropriate
• Perform claims system administrative and configuration support, including creating or modifying system letters, maintaining activity note types and templates, and managing other configurable system content (e.g., dotClaim)
• Support basic reporting and data-related tasks, including managing and modifying SSRS/Report Manager subscriptions and assisting with light troubleshooting and dataset validation
• Log, track, and help coordinate data and system-related projects to ensure visibility and accountability across teams
• Assist with user access, system setup, and operational support tasks as needed to maintain smooth daily claims system operations

Qualifications:

• Knowledge & Experience: Experience in claims adjudication preferred

Skills & Competencies

• Experience: 2-5 years of experience in Claims and/or Claims data analysis is a plus.
• Education: Bachelor’s degree preferred but not required.
• Technical Skills:
• Proficient in data analysis tools such as Excel, SQL, Python, or R.
• Experience with business intelligence tools (e.g., Tableau, Power BI).
• Familiarity with claims management systems and databases.
• Analytical Mindset: Strong problem-solving skills with the ability to analyze complex data sets and draw meaningful conclusions.
• Attention to Detail: Exceptional accuracy in reviewing and interpreting data.
• Communication: Excellent verbal and written communication skills to present findings and collaborate with cross-functional teams.